Risk factors for velopharyngeal dysfunction following orthognathic surgery in the cleft population

Area of Science:

• Craniofacial Surgery
• Speech Pathology
• Cleft Lip and Palate Research

Background:

• Orthognathic surgery is common for cleft lip and palate patients, but predicting speech outcomes, specifically velopharyngeal dysfunction, remains difficult.
• Preoperative risk factors are numerous and variable, often identified in studies with small sample sizes and design limitations.
• Understanding velopharyngeal port dynamics after maxillary advancement is crucial but insufficient for accurate prediction.

Purpose of the Study:

• To review current trends and challenges in predicting speech outcomes after orthognathic surgery in cleft lip and palate populations.
• To identify key factors influencing velopharyngeal function post-surgery.
• To highlight areas for improved risk factor elucidation for postoperative velopharyngeal dysfunction.

Main Methods:

• Review of recent pharyngeal morphologic studies using computed tomography (CT) to assess volumetric changes.
• Analysis of perceptual and instrumental speech evaluations.
• Examination of cephalometric correlates and preoperative velar length assessments.

Main Results:

• CT studies reveal volumetric discrepancies in the pharyngeal airway between unilateral and bilateral cleft lip and palate populations post-surgery.
• Preoperative velar length has been identified as a significant risk factor for developing velopharyngeal dysfunction.
• 'Borderline' velopharyngeal insufficiency status pre-surgery also shows predictive value.

Conclusions:

• Heterogeneity in research design and small patient cohorts hinder definitive identification of velopharyngeal dysfunction risk factors.
• Recent advancements in assessing pharyngeal airway volume and preoperative velar characteristics offer enhanced predictive capabilities.
• Further research with robust designs is needed to refine prediction models for speech outcomes in this population.