SA2 - Evaluating Risk Factors for Velopharyngeal Insufficiency Following Orthognathic Surgery in Cleft Palate Patients

Abstract:

Background: Orthognathic surgery is recommended for patients with a history of cleft palate to correct midface hypoplasia around late adolescence. These procedures may lead to velopharyngeal insufficiency (VPI), due to manipulation and advancement of the soft palate, pharyngeal walls, and oral cavity. Although factors leading to VPI following palatoplasty in infants have been thoroughly studied, the factors leading to VPI following orthognathic surgery require additional investigation. The aim of this study was to assess predictors of VPI following orthognathic surgery in adolescents with previously repaired cleft palate.

Methods: A retrospective review was conducted of non-syndromic patients with repaired cleft palate who underwent orthognathic surgery at a major children’s hospital between 1991 and 2024. Patients with less than six months of follow-up were excluded from our study. Data collected included demographics, surgical history, nasopharyngoscopy findings, and speech assessments performed by certified speech and language pathologists. Univariate and multivariate regression analysis were performed to identify the predictive value of each variable for post-operative VPI.

Results: A total of 127 patients met the criteria, with a mean age of 17.6 years at orthognathic surgery. One hundred and one patients (79.5%) underwent Le Fort I maxillary advancement and 13 (28.3%) underwent distraction osteogenesis. The postoperative VPI rate was 22%. Univariate analysis revealed that White race, Veau class IV, recurrent palatal fistulas, Le Fort I advancement, and the length of maxillary advancement were potential predictors of VPI. Multivariate analysis confirmed that Veau class IV (P = .014), recurrent palatal fistulas (P = .001), and length of maxillary advancement (P < .001) were true predictors of VPI. Receiver operating curve analysis determined a 7.5 mm threshold for maxillary sagittal advancement as the optimal measure to minimize the risk of VPI.

Conclusion: This study identifies several key predictors of VPI following Le Fort orthognathic surgery in patients with repaired cleft palates. Length of maxillary advancement, history of Veau class IV, and history of recurrent palatal fistulas significantly predicted development of VPI. These findings underscore the need for careful preoperative assessment and planning to mitigate the risk of post-surgical VPI, particularly in patients with complex cleft palate histories.