Evaluation of velopharyngeal insufficiency after orthognathic surgery in individuals with cleft lip and palate

Context: Maxillary advancement (MA) through Le Fort I osteotomy is routinely performed in individuals with cleft lip and palate (CLP) to correct maxillomandibular discrepancies. However, concerns remain regarding its potential impact on velopharyngeal function (VPF), particularly the development or worsening of velopharyngeal insufficiency (VPI). Most previous studies rely on perceptual assessment, while objective instrumental data are limited. Aim: The aim of this study was to investigate the incidence of VPI after MA using Le Fort I osteotomy in individuals with CLP, based on objective instrumental assessment, and to explore possible associations with clinical variables. Settings and Design: This retrospective cohort study was conducted at a tertiary craniofacial rehabilitation center. Methods: The sample consisted of 121 nonsyndromic adults with CLP treated between 2010 and 2022. All participants underwent primary cleft repair and MA at the same institution. VPF was assessed using the pressure–flow technique at three time points: preoperatively, 3–6 months postoperatively, and 12–18 months postoperatively. The velopharyngeal orifice area was calculated and classified into four categories from adequate to inadequate. Statistical Analyses Used: Descriptive and inferential statistical analyses were performed. Results: At the late postoperative evaluation, 4.1% of participants demonstrated inadequate VPF. Some individuals presented borderline or inadequate function preoperatively or at early follow-up, while others showed deterioration over time. No significant association was found between VPI and cleft type. Conclusions: The incidence of VPI after MA was low when assessed using objective instrumental methods, reinforcing their importance as complementary tools to perceptual speech evaluation in individuals with CLP.