Le Fort I Osteotomy in Cleft Patients: Maxillary Advancement and Articulation

Abstract

Background: Maxillary advancement may affect speech in cleft patients. Aims: To examine whether the amount of maxillary advancement and preoperativecephalometric skeletal and dentoalveolar relationships are associated with articulation errors of the Finnish alveolar consonants /s/, /l/, and /r/ in cleft patients. Materials and Methods: Fifty-seven nonsyndromic cleft patients who underwent Le Fort I or bimaxillary osteotomies were evaluated retrospectively. Pre-and post-operative lateral cephalometric radiographs and standardized speech video recordings were analyzed. The Aspin-Welch unequal variance t test, Student t test sign test, intraclass correlation and Kappa statistics were used in the statistical analyses. Results: The mean advancement of the maxilla (point A) was 4.65 mm horizontally (range À2.80 to 11.30) and À3.82 mm vertically (range À14.20 to 3.90). The overall articulation (especially the sounds /s/ and /l/) improved significantly postoperatively, but the amount of maxillary advancement did not affect the articulation. The preoperative mean percentages of /s/, /l/, and /r/ errors were 32%, 33%, 46% and the postoperative percentages 23%, 19%, 40%, respectively. Preoperative articulation errors of /s/ were related to palatal inclination of the upper incisors. Conclusions: Orthognathic surgery may improve articulation errors. The amount of maxillary advancement is not related to the improvement.