title: Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A 2-Institutional Study.
abstract: BACKGROUND
  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 study, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery.
  
  
  METHODS
  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 2 institutions. Chi-square test, Student's t test, and logistic regression analyses were performed.
  
  
  RESULTS
  In 214 patients reviewed (mean age, 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.2% had unilateral cleft lip and palate, and 20.6% had bilateral cleft lip and palate. A total of 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 sella-to-nasion-to-B point angle (mean, 79.0-76.3 degrees, P = 0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by A point-to-nasion-to-B point angles >0.5 (P = 0.02).
  
  
  CONCLUSIONS
  Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships because of the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Frances
authors.initials: F
authors.lastname: Yoshikane
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Li Han
authors.initials: LH
authors.lastname: Lai
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Hui
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Martins
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Gina
authors.initials: G
authors.lastname: Farias-Eisner
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Mandelbaum
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Han
authors.initials: H
authors.lastname: Hoang
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Libby
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
authors.forename: Justine C
authors.initials: JC
authors.lastname: Lee