Abstract
Cleft lip and palate is the most common congenital craniofacial anomaly. Up to 60% of these patients will benefit from cleft orthognathic surgery, which consists primarily of maxillary advancement and mandibular setback to address midface retrusion and relative mandibular protrusion, respectively. It is believed that maxillary advancement can enlarge the airway whilst mandibular setback can reduce the airway, but this has not previously been quantified for cleft patients undergoing orthognathic surgery. This unique longitudinal prospective study of 18 patients was conducted between April 2013 and July 2016. No significant changes occurred by six months postoperatively in body mass index, apnoea-hypopnoea index or lowest oxygen saturation (LSAT). There was a mean increase of 0.73 cm3 in velopharyngeal volume, a mean decrease of 0.79 cm3 in oropharyngeal volume, an improvement in snoring index, and no statistically significant change in hypopharyngeal volume. In conclusion, cleft orthognathic surgery that produced anterior advancement of the maxilla, setback of the mandible and clockwise rotation of the maxillo-mandibular complex resulted in increased velopharyngeal, decreased oropharyngeal and unchanged hypopharyngeal airways, and improved snoring, but did not significantly alter objective sleep-related breathing function.
Highlights
During more than three decades, our Craniofacial Center has progressively optimised our management strategies for our patients with cleft lip and palate
Airway obstruction is frequent in cleft children who undergo speech surgical intervention[6,7,8]
There were no significant changes in apnoea-hypopnoea index (AHI)/hr (1.99 ± 2.90 vs 1.86 ± 2.69; p = 0.81), lowest oxygen saturation (LSAT) (90.89 ± 5.85 vs 92 ± 4.90; p = 0.168) or nasal septum deviation (NSD) (p = 1.000) before and after surgery
Summary
During more than three decades, our Craniofacial Center has progressively optimised our management strategies for our patients with cleft lip and palate. One long-term negative effect of these early surgical interventions is a significant incidence of maxillary growth restriction that produces secondary deformities of the jaws and malocclusion, which affects speech, airway and self-esteem[1]. Up to 60% of cleft patients will require orthognathic surgery[2]. If a patient has residual maxillofacial deformities (mid-face retrusion and mandibular protrusion) in adolescence, our management is to combine Le Fort I maxillary advancement and bilateral sagittal split setback with single splint techniques[3,4]. Airway obstruction is frequent in cleft children who undergo speech surgical intervention[6,7,8]. The effects of cleft orthognathic surgery (maxillary advancement and mandibular setback) on the airway are still unknown. The objective of this study is to evaluate airway changes after cleft orthognathic surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
