Cleft distraction versus orthognathic surgery - which one causes less disturbance on resonance?

Abstract

Objective: To compare the speech outcome of cleft lip and palate patients (CLP) undergoing maxillary Le Fort I advancement by either distraction osteogenesis with internal distractor or conventional osteotomy with miniplate fixation. Methods: This is a prospective randomized controlled study comparing the two treatment techniques with CLP needing maxillary advancement of 4–10 mm. All patients received full speech assessment pre-operatively and at 3 months post-operatively. Nasalance data were collected and analysed using the Kay Elemetrics Model 6200 Nasometer. A nasalance value higher than 30% was considered to be suggestive of hypernasality. Results: Fifteen patients underwent distraction and 15 had conventional osteotomy. In the distraction group, 2 patients who had nasalance scores of above 30% pre-operatively were noted to have decreased at 3 months post-op. One patient who had nasalance scores of below 30% pre-operatively had a score of 32.88% postoperatively. In the osteotomy group, one patient with a nasalance score of more than 32.87% was found to have a score of 41.15% at 3 months post-op. Four patients who had a nasalance score below 30% had an increase to more than 30% post-operatively which was considered to be indicative of hypernasality. Conclusion: Advancement of the cleft maxilla can result in either increases or decreases in nasalance in the early post-operative period for both surgical methods. The study illustrates individual differences in compensation to structural changes, as well as the need for longer-term follow-up, as planned in our study.