Identifying Predictors of Acquired Velopharyngeal Insufficiency in Cleft Lip and Palate Following Maxillary Osteotomy Using Multiple Regression Analyses
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AbstractBackground: Maxillary osteotomy is typically undertaken to correct abnormal facial growth in Cleft Lip and Palate (CLP). The surgery can cause velopharyngeal insufficiency (VPI) resulting in hypernasality. This study aims to identify valid predictors of acquired VPI following maxillary osteotomy by using a range of perceptual and instrumental speech investigations and multiple regression.
Methods: A prospective study was undertaken consisting of a consecutive series of patients with CLP (N=20) undergoing maxillary osteotomy by a single surgeon. Participants were seen at: 0-3 months pre-surgery (T1), 3-months (T2) and 12-months (T3) post-surgery. Hypernasality was rated using the Cleft Audit Protocol for Speech-Augmented (CAPS-A) and visual analog scales, and nasalance was measured on the Nasometer II 6400. For lateral videofluorosopic and nasendoscopic images, visual perceptual ratings (VPRs) and quantitative ratiometric measurements (QRMs) were undertaken. Multiple regression analyses were undertaken to identify predictors.
Results: T3 models with hypernasality as the dependent variable were found to be a good fit and significant (e.g. CAPS-A: R2 = .920, F(11,7) = 7.303, p = .007). Closure ratio (a QRM) and proportion of palate contacting the posterior pharyngeal wall (a VPR) were identified as significant predictors for the CAPS-A model (p = .030, p = .002).
Conclusions & Implications: Lateral videofluoroscopy is useful in the identification of valid predictors of acquired VPI following maxillary osteotomy in CLP. However, a combination of VPRs and QRAs is indicated. Clinical implications are around the assessment protocol and informed consent process to surgical intervention.
All Author(s) ListPereira V., Tuomainen J., Hay N., Mars M., Suchak A., Sell D.
Journal nameThe Journal of Craniofacial Surgery
Volume Number31
Issue Number8
PublisherWolters Kluwer
Pages2260 - 2266
LanguagesEnglish-United Kingdom
Keywordscleft palate, velopharyngeal insufficiency, orthognathic surgery, speech

Last updated on 2021-15-04 at 23:32