title: Pharyngeal Flap Is Effective Treatment for Post Maxillary Advancement Velopharyngeal Insufficiency in Patients With Repaired Cleft Lip and Palate.
abstract: OBJECTIVE
  Patients with repaired cleft lip and cleft palate (CL/P) can develop velopharyngeal insufficiency (VPI) after Le Fort I maxillary advancement. The aim of this study was to evaluate speech outcomes in patients who required a pharyngeal flap after Le Fort I maxillary advancement.
  
  
  METHODS
  This retrospective cohort study included all patients with repaired CL/P who underwent a Le Fort I osteotomy and subsequently required a pharyngeal flap to correct VPI. Patients were included if they had outcome measurements documented at 3 time points: 1) before Le Fort I (baseline), 2) after Le Fort I, and 3) after pharyngeal flap. Outcome measurements, including speech characteristics (resonance, nasal emission, and intraoral pressure) and velopharyngeal function, were evaluated on perceptual assessment by a speech pathologist specializing in cleft care. Velopharyngeal closure was assessed with multi-view videofluoroscopy or nasopharyngoscopy. Patient characteristics and descriptive statistics were summarized and continuous data were expressed as mean ± standard deviation. Repeated-measures analysis of variance and paired samples t test were used to measure changes in speech outcome variables between time points. All P values were 2-tailed and considered significant for values less than .05.
  
  
  RESULTS
  There were 23 patients for analysis (13 girls [56.5%] and 10 boys [43.5%]). Two patients (9%) had cleft palate only, 9 (39%) had unilateral cleft lip and palate (CLP), and 12 (52%) had bilateral CLP. Follow-up evaluations performed on average 12 months postoperatively showed statistically meaningful improvement for all variables, including decreased hypernasality, reduced nasal emission, and increased intraoral pressure for consonant production. Patients with repaired CL/P who had VPI after Le Fort I maxillary advancement showed significant improvement in all outcome measurements after pharyngeal flap (P < .001).
  
  
  CONCLUSIONS
  The superiorly based pharyngeal flap is highly successful in correcting VPI after Le Fort I maxillary advancement in patients with repaired CL/P.
authors: Clinical Research Fellow, Harvard Medical School, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors: Kelley M
authors: KM
authors: Dentino
authors: Research Instructor, Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY.
authors: Eileen M
authors: EM
authors: Marrinan
authors: Research Coordinator, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors: Katherine
authors: K
authors: Brustowicz
authors: Professor of Surgery, Harvard Medical School, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors: John B
authors: JB
authors: Mulliken
authors: Associate Professor, Harvard School of Dental Medicine; Oral-Surgeon-in-Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: Bonnie.Padwa@childrens.harvard.edu.
authors: Bonnie L
authors: BL
authors: Padwa
mesh_terms: D000293:Adolescent; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery; D019340:Osteotomy, Le Fort / Q000379:methods; D010614:Pharynx / Q000601:surgery*; D013060:Speech; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D055815:Young Adult