Evaluation of velopharyngeal changes and mechanisms in upper airway following maxillary advancement by LeFort I osteotomy in patients with cleft: A retrospective study

Abstract

Introduction: Velopharyngeal dysfunction after maxillary advancement in Lefort I osteotomy may be a result of velopharyngeal insufficiency in patients with cleft. Maxillary hypoplasia is often related to a combination of congenital decrease in midfacial growth and surgical scar from cleft palate repair. Aims and Objectives: The aims and objectives of this study are to evaluate and correlate the velopharyngeal changes during and after maxillary advancement in patients with cleft after Lefort I osteotomy. Materials and Methods: Thirty Class III patients were included in this study. Maxillary advancement was done with Lefort I osteotomy. Cephalometric, nasopharyngoscope, and nasometer records were taken before, immediate postoperative and 1 year after advancement. A paired t-test was used to find the differences at P < 0.05. Results: The range of maxillary advancement was almost at mean of 9 mm. Statistical increase in the anteroposterior distance of superior, middle and inferior velopharynx, nasopharyngeal and oropharyngeal dimensions, angle of velar, and need ratio was found (P = 0.0001). There was a significant increase in nasalance scores (P < 0.041). Sagittal maxillary changes were 9.77° postadvancement. Vertical changes in maxilla, ANS, and peripheral nerve stimulation relative to X-axis (P = 0.0001, 0.0001 and 0.018) significantly increased after surgery. A significant positive correlation was seen between the amount of maxillary advancement and increase in depth of nasopharynx (P = 0.0001). Conclusions: The maxilla was advanced forward causing increased nasopharyngeal depth. There was a positive correlation between the amount of maxillary advancement and nasopharyngeal depth.

Keywords

• cleft lip and palate
• flexible fiberoptic nasopharyngoscope
• nasalance
• nasometer
• orthognathic surgery
• velopharyngeal dysfunction