Introduction
Orthognathic surgery (OGS) seeks to correct midfacial hypoplasia in cleft patients. However, Le Fort I maxillary advancement will likely worsen velopharyngeal function after OGS. This study investigates the impact of two-jaw OGS on velopharyngeal insufficiency (VPI) and assesses the risk factors for inferior post-OGS VP outcomes.
Patients and Methods
162 consecutive cleft patients undergoing two-jaw orthognathic surgery from January 2015 to December 2020 in Chang Gung Craniofacial Center were enrolled. Perceptual assessment for VP function and cephalometric analysis before and after OGS were documented. The pre and post-OGS VP function changes were exhibited. A logistic regression model was used for risk analysis of VP function worsening.
Results
After OGS, the VP function was unchanged in 80.9% of the patients, while 3.7% had improving VP function, but 14.2% worsened. The VP function changes after OGS are statistically significant among those with different pre-OGS VP statuses (p = 0.017). Multivariate logistic regression showed maxillary advancement amount was an independent risk factor for post-OGS worsening VP function (OR = 1.74, 95% CI = 1.20-2.52, p = 0.004). The receiver operating characteristic curve based on maxillary advancement demonstrated good discrimination with an area under the curve of 0.727 (95% CI = 0.62-0.83, p = 0.001). The Youden index was 4.27 (mm).
Conclusions
The VP function is at risk of deterioration after OGS in cleft patients. The amount of maxillary advancement has a negative impact on VP function.

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