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Войти в исследования Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
How Often is Speech Surgery Recommended After Le Fort I Advancement in Patients With Preoperative Borderline Velopharyngeal Insufficiency?
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Best David L, Thean David C, Clark Roseanne E, Padwa Bonnie L
Аннотация
BACKGROUND: Children with repaired cleft lip and palate (CLP) often develop maxillary hypoplasia requiring Le Fort I (LF1) advancement. Patients with preoperative velopharyngeal insufficiency (VPI) are at high risk for worsening velopharyngeal function after LF1 advancement, while those with normal preoperative function are at low risk. However, speech outcomes in patients with preoperative borderline VPI are poorly understood.
PURPOSE: The study purpose was to estimate the frequency of recommended speech surgery among subjects with preoperative borderline VPI following LF1 advancement and its association with magnitude of maxillary advancement.
STUDY DESIGN, SETTING, AND SAMPLE: This was a single-institution, retrospective cohort study of subjects with repaired CLP and borderline VPI who underwent LF1 advancement between 2014 and 2023 at Boston Children's Hospital. Subjects without speech assessments were excluded.
PREDICTOR VARIABLE: The predictor variable was sagittal magnitude of maxillary advancement (mm).
MAIN OUTCOME VARIABLE(S): The primary outcome was recommendation for secondary speech surgery, coded as yes/no. The secondary outcome was the change in Pittsburgh Weighted Speech Scale (PWSS) score.
COVARIATES: Covariates included age, sex, syndromic status, cleft type, and prior speech surgery.
ANALYSES: Demographic data were summarized with descriptive statistics. χ2 and Fisher tests evaluated categorical associations, and analysis of variance was used for continuous analyses. Logistic regression assessed the association between magnitude of maxillary advancement and need for speech surgery, and linear regression assessed the relationship between maxillary advancement and change in PWSS score. Significance was set at P < .05.
RESULTS: There were 51 included subjects, and 31 (60.8%) were male. The mean age was 18.3 ± 2.5 years). There were 28 (54.9%) subjects that were recommended speech surgery after LF1 (RR: 1.2; 95% CI, 0.8 to 1.8). Frequency of recommended speech surgery was not associated with categorical magnitude of maxillary advancement (P = .1) or continuous magnitude of advancement (P = .6). The mean PWSS score increased by 2.4 ± 4.0 points (P < .001) and did not differ by the magnitude of advancement (P = .5).
CONCLUSION AND RELEVANCE: Patients with CLP and preoperative borderline VPI are likely to require speech surgery following LF1 advancement, independent of magnitude of maxillary advancement. This should be discussed as part of routine preoperative counseling with patients and families.
PURPOSE: The study purpose was to estimate the frequency of recommended speech surgery among subjects with preoperative borderline VPI following LF1 advancement and its association with magnitude of maxillary advancement.
STUDY DESIGN, SETTING, AND SAMPLE: This was a single-institution, retrospective cohort study of subjects with repaired CLP and borderline VPI who underwent LF1 advancement between 2014 and 2023 at Boston Children's Hospital. Subjects without speech assessments were excluded.
PREDICTOR VARIABLE: The predictor variable was sagittal magnitude of maxillary advancement (mm).
MAIN OUTCOME VARIABLE(S): The primary outcome was recommendation for secondary speech surgery, coded as yes/no. The secondary outcome was the change in Pittsburgh Weighted Speech Scale (PWSS) score.
COVARIATES: Covariates included age, sex, syndromic status, cleft type, and prior speech surgery.
ANALYSES: Demographic data were summarized with descriptive statistics. χ2 and Fisher tests evaluated categorical associations, and analysis of variance was used for continuous analyses. Logistic regression assessed the association between magnitude of maxillary advancement and need for speech surgery, and linear regression assessed the relationship between maxillary advancement and change in PWSS score. Significance was set at P < .05.
RESULTS: There were 51 included subjects, and 31 (60.8%) were male. The mean age was 18.3 ± 2.5 years). There were 28 (54.9%) subjects that were recommended speech surgery after LF1 (RR: 1.2; 95% CI, 0.8 to 1.8). Frequency of recommended speech surgery was not associated with categorical magnitude of maxillary advancement (P = .1) or continuous magnitude of advancement (P = .6). The mean PWSS score increased by 2.4 ± 4.0 points (P < .001) and did not differ by the magnitude of advancement (P = .5).
CONCLUSION AND RELEVANCE: Patients with CLP and preoperative borderline VPI are likely to require speech surgery following LF1 advancement, independent of magnitude of maxillary advancement. This should be discussed as part of routine preoperative counseling with patients and families.