Association of Sphincter Pharyngoplasty and Long-Term Maxillary Hypoplasia in Patients with Cleft Palate

The current literature on orthognathic growth outcomes after velopharyngeal insufficiency surgery is limited by cohort size or short follow-up duration after surgery. This study evaluates the relationship between sphincter pharyngoplasty and long-term maxillomandibular growth.

All patients with cleft lip and palate (CLP) or isolated cleft palate (iCP) greater than or equal to 15 years of age who underwent sphincter pharyngoplasty from 1992 to 2023 were retrospectively reviewed. An age- and diagnosis-matched control group with CLP/iCP was also identified. Postoperative outcomes include clinical diagnosis of maxillary and mandibular hypoplasia, indication for Le Fort surgery, and sella-nasion-A point and sella-nasion-B point angles.

A total of 200 CLP/iCP patients with a mean age of 20.0 ± 3.2 years were included ( n = 114 with pharyngoplasty and n = 86 controls). Within the surgery cohort, pharyngoplasty occurred at a mean age of 12.0 ± 4.5 years with a follow-up duration 9.2 years (interquartile range, 3.5 to 12.2 years) after surgery. Maxillary hypoplasia was diagnosed twice as frequently in pharyngoplasty patients compared with controls (60.5% versus 33.7%; P < 0.001), corresponding to a higher incidence of Le Fort I surgery (45.6% versus 15.1%; P < 0.001) and smaller sella-nasion-A point angles (75.4 ± 4.5 degrees versus 78.2 ± 5.4 degrees; P = 0.03). There were no differences in mandibular hypoplasia or sella-nasion-B point angles. Multivariable analysis indicated that pharyngoplasty was independently associated with a 3-fold increase in later diagnosis of maxillary hypoplasia (OR, 3.8; 95% CI, 1.9 to 7.5; P < 0.001).

Patients with a history of pharyngoplasty were 3.8 times more likely to be subsequently diagnosed with maxillary hypoplasia, highlighting the need for longitudinal follow-up of patients after velopharyngeal insufficiency surgery, as there may be long-term orthognathic consequences.

Therapeutic, III.