Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A Two Institutional Study
Thomas Willson, MD, Rizal Lim, MD, Rachel Mandelbaum, BA, Deborah Martins, BA, James Bradley, MD, Libby Wilson, MD, Justine C. Lee, MD, PhD.
University of California Los Angeles, Los Angeles, CA, USA.
Understanding long term sequelae of cleft treatment is paramount in the refinement of treatment algorithms to accomplish optimized immediate and long term outcomes. In this work, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery.
Cleft lip/palate and cleft palate patients, 15 years of age and older, were reviewed for demographics, VPI surgery, revisions, and subsequent orthognathic surgery at two institutions. Chi square, Student’s t test, and logistic regression analyses were performed.
In 214 patients reviewed (mean age 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.5% had unilateral cleft lip and palate (CLP), and 20.7% had bilateral CLP. 33.6% were diagnosed with VPI and received a sphincter pharyngoplasty (mean age 11.9 years). When subsequent orthognathic surgery was examined, sphincter pharyngoplasty was not associated with maxillary advancement (p=0.59), but did correlate with an increase in mandibular surgery from 2.8% to 11.1% (p=0.02). The indications for mandibular surgery in the pharyngoplasty population were related to congenital micrognathia. When cephalometric analyses were evaluated, sphincter pharyngoplasty resulted in a decreased SNB angle (mean 79.0 to 76.3 degrees, p=0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by ANB angles >0.5 (p=0.02).
Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships due to the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur.
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