The effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status: a critical review.
OBJECTIVE
To review the impact of maxillary advancement by orthognathic surgery and distraction osteogenesis on speech and velopharyngeal status based on the literature of the past 30+ years, to review the methods employed in previous studies to explain discrepancies in results, and to make recommendations for future studies.


METHODS
Thirty-nine published articles on the effect of cranio-maxillofacial osteotomies and distraction osteogenesis on speech and velopharyngeal status were identified and were systematically analyzed. A total of 747 cases of cleft and noncleft patients were selected, including craniofacial deformities and syndromes mainly involving maxillary hypoplasia.


RESULTS
Findings varied. Many studies found that surgery had no impact on speech and velopharyngeal status. Some reported worsening only in patients with preexisting velopharyngeal impairment or those with borderline velopharyngeal function before surgery. There was no clear difference in outcome between distraction and conventional osteotomy, although there have been few systematic comparisons. There was great variation among reviewed studies in the number of subjects, speech sample, number and type of listeners, speech outcome measures, and timing of postoperative assessment. Few studies employed reliability measures.


CONCLUSIONS
None of the 39 reviewed studies compared conventional osteotomy and distraction by including both groups in a single study. Randomized controlled trials with adequate number of subjects and follow-up duration are needed.
Chanchareonsook
Nattharee
N
University of Hong Kong, Hong Kong, China.
Samman
Nabil
N
Whitehill
Tara L
TL
D001184:Articulation Disorders / Q000601:surgery*; D002508:Cephalometry; D002971:Cleft Lip / Q000150:complications; D002972:Cleft Palate / Q000150:complications; D004724:Endoscopy; D005471:Fluoroscopy; D006801:Humans; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D019857:Osteogenesis, Distraction; D019340:Osteotomy, Le Fort; D063173:Retrognathia / Q000209:etiology / Q000601:surgery; D025363:Rhinomanometry; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D014832:Voice Disorders / Q000601:surgery*