The impact of orthognathic surgery on velopharyngeal function by evaluating speech and cephalometric radiographs

Publication date: Available online 3 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): D. Impieri, K.A. Tønseth, Ø. Hide, E.L. Brinck, H.E. Høgevold, C. Filip

Abstract

Background

: Maxillary retrognathia is a well-known consequence of abnormal facial growth in patients with cleft lip and palate. Orthognathic surgery improves facial appearance and occlusion, but may induce velopharyngeal insufficiency. The aim of the study was to evaluate the effect of orthognathic surgery on velopharyngeal function using speech analysis and lateral cephalometric radiographs.

Patients and Methods

: A retrospective study of 47 patients who underwent maxillary advancement ± mandibular setback between 2006 and 2016. Pre- and 1-year postoperative audio recordings were blinded for scoring by three trained speech therapists. Pre- and 1-year postoperative lateral cephalometric radiographs were used to obtain information about skeletal movement and its relationship with the velopharyngeal area. Correlations between the speech outcomes and cephalometric radiographs were calculated.

Results

: Hyponasality improved significantly after surgery (p<0.05), while hypernasality deteriorated significantly only in the patients who underwent maxillary advancement alone (p<0.05). No difference in speech parameters was found between patients with hypernasality or patients who had a pharyngoplasty preoperatively and the rest of the group. No correlation was found between amount of maxillary advancement and hypernasality. Significant correlation (r< -0.49, p<0.05) was found between preoperative velar length and hypernasality postoperatively.

Conclusions

: Maxillary advancement has a negative impact on velopharyngeal function, while bimaxillary surgery seems to protect from deterioration. No difference was found in the amount of maxillary advancement or in velopharyngeal measurements between the Le Fort I and the bimaxillary group. A short soft palate is a predictor of hypernasality after orthognathic surgery.