Velopharyngeal insufficiency after maxillary advancement in patients with cleft palate − a survey of risk assessment in the United Kingdom and Ireland

Fitzgerald, Rhian; Smyth, A.G.

doi:10.1016/j.bjoms.2018.11.006

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Orthognathic surgery-induced VPI typically results from significant maxillary advancement (>10 mm) 36 . Such significant advancement can increase the patient's pharyngeal space anteroposteriorly, preventing the smaller velum from accommodating and closing the VP port 12,37 . Although not every cleft-orthog-nathic procedure results in speech deterioration, more extensive maxillary advancement is associated with a greater VPI development risk 38 …”

Section: Discussionmentioning

confidence: 99%

“…36 Such significant advancement can increase the patient's pharyngeal space anteroposteriorly, preventing the smaller velum from accommodating and closing the VP port. 12,37 Although not every cleft-orthog-nathic procedure results in speech deterioration, more extensive maxillary advancement is associated with a greater VPI development risk. 38 For VPI induced by maxillary advancement, little to no research has demonstrated 1 reparative technique to be superior.…”

Section: Newly-developed Vpi Post-orthognathic Surgerymentioning

confidence: 99%

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A Preliminary Management Algorithm for Velopharyngeal Insufficiency in Cleft-Orthognathic Patients

Sasson

Reátegui

Phillips

et al. 2022

Journal of Craniofacial Surgery

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Purpose: Patients born with a cleft palate often suffer from velopharyngeal insufficiency (VPI) due to the soft palate musculature's abnormal structure. Surgical correction of the palate at a young age can hinder maxillary growth, requiring surgical correction of the maxillomandibular discrepancy at skeletal maturity. Orthognathic surgery can then cause or further exacerbate VPi in these patients. The purpose of this paper is to assess cleft-orthognathic patients under the lens of persistent or newly-developed VPi, to understand outcomes and generate a targeted management algorithm. Methods: A retrospective study was performed inspecting cleftorthognathic patients presenting to a single surgeon. Patients with sufficient follow-up were placed into predefined algorithmic cohorts by their VPi development pattern in relation to orthognathic surgery. They were further stratified into groups by level of adherence to our algorithm to evaluate VPi outcomes. Demographic factors, risk factors, and outcomes were compared between groups via Welch t test and Fisher exact test.Results: Fifty-one patients were examined, including 16 with VPI. Velopharyngeal insufficiency fully resolved amongst all algorithmically adherent patients and remained in nonadherent patients (P < 0.001). Conclusions: Our targeted algorithm may improve symptoms and the management of VPI in cleft-orthognathic patients. Multicentered studies with larger sample sizes and prospective studies are encouraged to validate our proposed treatment algorithm further.

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Section: Discussionmentioning

confidence: 99%

Section: Newly-developed Vpi Post-orthognathic Surgerymentioning

confidence: 99%

A Preliminary Management Algorithm for Velopharyngeal Insufficiency in Cleft-Orthognathic Patients

Sasson

Reátegui

Phillips

et al. 2022

Journal of Craniofacial Surgery

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“…Even in two studies that describe perception-based data this is limited to the experiences of professionals via online survey methods (21,22). Only one study deployed a purely qualitative research design in which Visram and colleagues (23) report on issues affecting quality of life (QoL) of adult patients with craniofacial anomalies, applying a framework method to analyse data acquired through individual patient interviews.…”

Section: Introductionmentioning

confidence: 99%

The role of qualitative research in oral and maxillofacial surgery

Baker¹,

Knepil²,

Courtney³

2022

British Journal of Oral and Maxillofacial Surgery

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“…Approximately 25% of young adults with a cleft palate may require orthognathic surgery for maxillary retrognathia after completion of skeletal growth (Woo, 2017). Maxillary advancement has been associated with deterioration in velopharyngeal function (Chanchareonsook et al, 2006;Fitzgerald & Smyth, 2019), but paradoxically, the improvement in the occlusal relationship of the jaws may improve articulation (Pereira et al, 2013;Hagberg et al, 2019;Alaluusua et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age

Fell

Medina

Fitzsimons

et al. 2021

The Cleft Palate Craniofacial Journal

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Objective: This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age. Participants: In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study. Outcome Measures: Maxillary growth was analyzed using dental models scored by the 5-Year-Olds’ index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech – Augmented rating. Results: Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old’ index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth ( P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth. Conclusion: The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.

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Velopharyngeal insufficiency after maxillary advancement in patients with cleft palate − a survey of risk assessment in the United Kingdom and Ireland

Cited by 6 publications

References 10 publications

A Preliminary Management Algorithm for Velopharyngeal Insufficiency in Cleft-Orthognathic Patients

A Preliminary Management Algorithm for Velopharyngeal Insufficiency in Cleft-Orthognathic Patients

The role of qualitative research in oral and maxillofacial surgery

The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age

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