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Correlation Between Speech Outcomes and the Amount of Maxillary Advancement After Orthognathic Surgery (Le Fort I Conventional Osteotomy and Distraction Osteogenesis) in Patients With Cleft Lip and Palate

Chung, Jeehyeok MD*; Lim, Joonho MD; Park, Hyunyoung; Yoo, Anna MD§; Kim, Sukwha MD; Koo, Yountaek MD||

doi: 10.1097/SCS.0000000000005623
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Background: The purpose of this study is to evaluate the factors affecting the speech outcome following Le fort I conventional osteotomy(CO) or Le Fort I distraction osteogenesis(DO) in patients with cleft lip and palate at a single institution.

Method: Records of cleft lip and palate patients who underwent orthognathic surgery between 2010 and 2015 were reviewed. Data included age at orthognathic surgery, sex, cleft lip and palate type, type of orthognathic surgery, the amount of maxillary advancement, and speech assessment. Speech outcomes were classified into 2 categories. Compared with the pre and post-operative Pittsburgh Weighted speech scale scores, in case that the post-operative total score is increased the authors define it as “Speech deterioration” and if not, the authors define it as “Speech preservation.”

Result: The 44 patients were identified, 33 patients underwent CO and 11 patients underwent DO. The mean age was 19.4 ± 1.4. The mean period time of speech evaluation after orthognathic surgery was 1.0 ± 0.46 year. The mean amount of maxillary advancement was 7.2 ± 3.2 mm and show significant correlation with speech outcomes. (P = 0.012) . In CO group, the patients who had the maxilla 1∼5 mm advancement maintained their speech completely and 44% of patients with 6∼8 mm deteriorated their speech. In DO group, patients with 9∼10 mm maintained their speech completely, 50% of patients with 11∼12 mm deteriorated their speech and 100% of patients with 13∼16 mm deteriorated their speech. According to the relationship between the amount of maxillary advancement and speech outcomes, there was a statistically significant correlation in both CO and DO groups. (P = 0.04, 0.029).

Conclusion: It was found that speech of the patients with more amount of maxillary advancement tended to get worse. Also, it was observed that there exist some stable ranges of maxillary advancement for speech safety which does not effect on speech. (1∼5 mm in CO group and 9∼10 mm in DO group).

*Department of Plastic Surgery, Myongji Hospital, Gyeonggi-do

Department of Plastic Surgery

Speech Hearing Center, Seoul National University Hospital

§Dream Plastic Surgery

||Wonjin Plastic Surgery, Seoul, Korea.

Address correspondence and reprint requests to Yountaek Koo, MD, Wonjin Plastic Surgery, Seoul, Korea, 419, Gangnam-daero, Seocho-gu, Seoul, Korea; E-mail: kooyountaek@gmail.com; Sukwha Kim, MD, Department of Plastic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110–744, Korea; E-mail: kimsw@snu.ac.kr

Received 20 October, 2018

Accepted 1 April, 2019

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com).

© 2019 by Mutaz B. Habal, MD.