The Effect of Maxillary Advancement on Velopharyngeal Insufficiency in Cleft Palate Patients: A Systematic Review and Meta-Analysis

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Dahaghin Mohammad Javad; Mirmohammad Sadeghi Hoori; Owneq Mostafa; Bastami Farshid; Tabrizi Reza

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Journal Paper

Paper Information

Journal: REGENERATION, RECONSTRUCTION & RESTORATION Year:2024 | Volume:9 | Issue:1 Page(s): 1-11

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Title

The Effect of Maxillary Advancement on Velopharyngeal Insufficiency in Cleft Palate Patients: A Systematic Review and Meta-Analysis

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Keywords

Maxillary advancement

velopharyngeal insufficiency

cleft lip

cleft palate

Abstract

Background and objectives: Maxillary advancement (MA) is a common surgical procedure for correcting facial-skeletal discrepancies in patients with cleft lip and palate. Despite its prevalence, the impact of MA on velopharyngeal insufficiency (VPI) remains a subject of debate. This systematic review and meta-analysis aims to evaluate the effect of MA on VPI in cleft palate patients. Materials and methods: Adhering to PRISMA 2020 guidelines this review included randomized controlled trials and observational studies assessing velopharyngeal function pre-and post-MA in cleft palate patients. Exclusion criteria encompassed studies on non-cleft palate patients and those lacking VPI assessments. Searches were conducted in databases like PubMed, MEDLINE, Embase, Scopus, and Cochrane Library, up to September 2023. Studies were selected and data was extracted by two independent reviewers, with disagreements resolved through consultation. The risk of bias was assessed using Cochrane's risk of bias tool. A meta-analysis was conducted using inverse variance meta-analysis with random effects for categorical data. Results: Eleven studies involving 524 patients were included. Studies varied in design, patient demographics, and type of cleft. MA procedures primarily involved LeFort I osteotomy. Speech and VPI assessments employed various methods. Analysis revealed a shift from normal to hypernasal speech postoperatively, with a general trend towards aggravated VPI, especially in cases of MA more than 6mm. The meta-regression (coefficient of-20. 35 with a standard error of 8. 63, a T-value of 2. 36, and a P-value of 0. 046) showed a significant relationship between the extent of MA and VPI outcomes. High heterogeneity was observed across studies. Conclusion: Maxillary advancement, especially when less than 6 mm, can negatively impact velopharyngeal insufficiency in patients with cleft palate. Successful outcomes require comprehensive preoperative assessment, precise surgical planning, collaborative care, and vigilant postoperative monitoring to minimize the risk of VPI and improve patient outcomes.

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