Assessing the Impact of LeFort I Osteotomy on Velopharyngeal Function in Patients With Cleft Palate: Comparing Outcomes Based on Prior VPI Management.

OBJECTIVE

Describe changes in symptoms of velopharyngeal insufficiency (VPI)-hypernasality, audible nasal emission, and VPI-related quality of life-following LeFort I osteotomy in individuals with cleft palate +/- cleft lip.

DESIGN

Single-center, retrospective cohort study.

PARTICIPANTS

Twenty-one patients with a history of cleft palate repaired in infancy were included in this study. Ten patients had no prior history of VPI surgery and eleven had a pharyngeal flap in place at the time of LeFort I osteotomy. The mean age at time of surgery was 17.2 years.

MAIN OUTCOME MEASURE

Pre- and postoperative hypernasality severity, frequency of audible nasal emission, and total score on the VPI Effects on Life Outcomes youth questionnaire (VELO-Y) before and after LeFort osteotomy I. Fischer exact test was used to assess differences between groups for categorical variables and a t test was used for continuous variables.

RESULTS

Patients with no prior history of VPI management had a significant increase in hypernasality severity compared with those with a pharyngeal flap in place at the time of surgery (P=0.004). Patients without a prior history of VPI management also had a significant increase in frequency of audible nasal emission, while patients with a pharyngeal flap had decreased audible nasal emission (P=0.004). There was not a significant difference between groups for change in the total score on the VELO-Y (P=0.16).

CONCLUSIONS

Findings from this study may improve preoperative counseling provided to patients and caregivers on the risk of acquiring VPI after LeFort I osteotomy based on prior VPI surgical history.