title: Uvulopalatopharyngoplasty, maxillomandibular advancement, and the velopharynx.
abstract: OBJECTIVE
  To evaluate the presence of velopharyngeal insufficiency (VPI) symptoms and the associated changes of the velopharyngeal anatomy in patients who underwent maxillomandibular advancement (MMA) for persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP).
  
  
  METHODS
  Preoperative and postoperative cephalometric radiographs were analyzed to assess the anatomic changes of the velopharynx. In addition, a questionnaire survey was sent to the patients between 6 to 12 months after MMA. The questionnaires evaluated the presence and extent of VPI symptoms, including nasal regurgitation while eating or drinking as well as hypernasal speech. A 10-cm visual analog scale (VAS 0-10) was included to assess the impact of VPI symptoms on the patient's quality of life. In the patients who reported VPI symptoms, telephone interviews were conducted 1 year after the survey to evaluate the changes in VPI symptoms over time.
  
  
  RESULTS
  Fifty-two of the 65 questionnaires were returned. Five patients (9.6%) reported nasal regurgitation of liquids when drinking hastily, with 2 patients reporting the occurrences as occasional and 3 patients reporting as rare. The impact of these symptoms on the patient's quality of life was minimal (VAS 0.6 +/- 0.4). Regurgitation of food or hypernasal speech was not reported. The telephone interviews 1 year later revealed that the symptoms have completely resolved in all 5 patients. Comparison of the preoperative and postoperative cephalometric radiographs demonstrated the pharyngeal depth increase was 48% of the amount of maxillary advancement and the functional pharyngeal length increased 53% of the maxillary advancement. The functional depth of the pharynx after MMA was significantly greater in the patients with VPI symptoms (P=.01).
  
  
  CONCLUSIONS
  The results of this study suggest that patients who undergo MMA for persistent OSA after UPPP have a low risk of developing VPI. If symptoms occur postoperatively, they are mild and have minimal effect on the patient's quality of life; moreover, the symptoms usually resolve over time.
authors.affiliation: Stanford University Sleep Disorders and Research Center, Stanford, California, USA. kaseyli@hotmail.com
authors.forename: K K
authors.initials: KK
authors.lastname: Li
authors.forename: R J
authors.initials: RJ
authors.lastname: Troell
authors.forename: R W
authors.initials: RW
authors.lastname: Riley
authors.forename: N B
authors.initials: NB
authors.lastname: Powell
authors.forename: U
authors.initials: U
authors.lastname: Koester
authors.forename: C
authors.initials: C
authors.lastname: Guilleminault
mesh_terms: D002508:Cephalometry; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D010160:Palate, Soft / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery*; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis / Q000601:surgery*