Speech outcomes following Le Fort I maxillary advancement in cleft lip and palate patients: A retrospective evaluation using the Borel-Maisonny classification

To analyse the effect of maxillary advancement on speech in patients born with unilateral or bilateral cleft lip and palate (uCLP/bCLP).

Using the retrospective cohort study design, the investigators included children with uCLP or bCLP who underwent Le Fort I osteotomy for maxillary advancement between January 2013 and December 2023 at a Swiss university hospital. Predictor variables were cleft type (uCLP/bCLP) and amount of maxillary advancement measured on lateral cephalograms. The primary outcome was speech competency evaluated by two speech therapists using the Borel-Maisonny classification (A: velopharyngeal competence/excellent speech; B: borderline competence/good speech; C: incompetence/poor speech). Appropriate statistical analyses were performed, and P < 0.05 was considered statistically significant.

Forty-three non-syndromic CLP patients (mean age 16.4 ± 1.5 years; 37 % female) were included. The mean maxillary advancement was 6.6 ± 2.3 mm. Of the 36 patients classified as A or B preoperatively, 34 showed no change, while two (5.6 %) deteriorated from A to B. All seven patients with preoperative category C remained unchanged. Neither cleft type nor the extent of maxillary advancement significantly influenced postoperative speech (p = 0.65 and p = 0.80, respectively).

Although limited by sample size, this study suggests that speech deterioration after maxillary advancement in CLP patients with preoperative category A or B is uncommon. Conversely, Le Fort I osteotomy does not appear to improve speech in patients with preoperative category C.