Orthognathic Consequences of Sphincter Pharyngoplasty in Cleft Patients: A 2-Institutional Study.

Autor:	Yoshikane F; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Lai LH; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Hui BK; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Martins DB; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Farias-Eisner G; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Mandelbaum RS; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Hoang H; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Bradley JP; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Wilson L; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif., Lee JC; Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif.; Division of Plastic and Reconstructive Surgery, Temple University, Philadelphia, Pa.; and Craniofacial/Cleft Palate Program, Orthopaedic Hospital, Los Angeles, Calif.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2016 Apr 07; Vol. 4 (4), pp. e676. Date of Electronic Publication: 2016 Apr 07 (Print Publication: 2016).
DOI:	10.1097/GOX.0000000000000656
Abstrakt:	Background: Understanding long-term sequelae of cleft treatment is paramount in the refinement of treatment algorithms to accomplish optimized immediate and long-term outcomes. In this study, we reviewed sphincter pharyngoplasties as a method of velopharyngeal insufficiency (VPI) treatment in relationship to orthognathic surgery. Methods: Cleft lip/palate and cleft palate patients, 15 years of age and older, were reviewed for demographics, VPI surgery, revisions, and subsequent orthognathic surgery at 2 institutions. Chi-square test, Student's t test, and logistic regression analyses were performed. Results: In 214 patients reviewed (mean age, 19.5 years), 61.7% were male, 18.2% had isolated cleft palate, 61.2% had unilateral cleft lip and palate, and 20.6% had bilateral cleft lip and palate. A total of 33.6% were diagnosed with VPI and received a sphincter pharyngoplasty (mean age, 11.9 years). When subsequent orthognathic surgery was examined, sphincter pharyngoplasty was not associated with maxillary advancement (P = 0.59) but did correlate with an increase in mandibular surgery from 2.8% to 11.1% (P = 0.02). The indications for mandibular surgery in the pharyngoplasty population were related to congenital micrognathia. When cephalometric analyses were evaluated, sphincter pharyngoplasty resulted in a decreased sella-to-nasion-to-B point angle (mean, 79.0-76.3 degrees, P = 0.02) and a higher incidence of normal to class II maxillomandibular relationships as defined by A point-to-nasion-to-B point angles >0.5 (P = 0.02). Conclusions: Sphincter pharyngoplasty decreases anterior mandibular growth and the discrepancy between maxillomandibular skeletal relationships because of the frequent predisposition of cleft patients to maxillary hypoplasia. In patients with congenital mandibular micrognathia, a small increase in mandibular surgeries may occur.
Databáze:	MEDLINE
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