Velopharyngeal insufficiency after maxillary advancement in patients with cleft palate - a survey of risk assessment in the United Kingdom and Ireland.

Patients with cleft lip and palate may require orthognathic surgery to correct severe impairments in midfacial growth. Maxillary advancement in this group, however, is linked to deterioration in velopharyngeal function (VPF), and it is not clear how cleft teams assess this risk. We therefore surveyed surgeons from 15 cleft units who provide orthognathic treatment, to gain an understanding of current practice in the UK and Ireland. A total of 16/21 surgeons from 14/15 units responded. While 14/16 surgeons agreed that these patients are at risk of a deterioration in VPF after maxillary advancement, two disagreed. Preoperative assessment of perceptual speech is required in all cases, but only 9/14 routinely did an instrumental assessment of VPF. One third of respondents thought that they could not identify "borderline" cases. There were differences in how surgeons obtained preoperative consent regarding deterioration in VPF, and whether surgical plans should be modified accordingly. There was considerable variation in current practice regarding risk, assessment, and management of potential changes in VPF after orthognathic surgery. A national forum for multidisciplinary discussion would allow for the standardisation of care across the UK and Ireland. Further study is needed to establish the effects of orthognathic surgery on VPF in this group, as well as the clinical benefits of instrumental assessments.