Incidence of Velopharyngeal Insufficiency Surgery Following Orthognathic Surgery in Cleft Lip and Palate

Objective: Orthognathic surgery is associated with a risk of compromising velopharyngeal function in patients with cleft lip and/or palate (CL/P), potentially necessitating subsequent velopharyngeal insufficiency (VPI) surgery. This study aimed to determine the incidence and predictors associated with VPI surgery following orthognathic surgery. Methods: Retrospective review of the TriNetX database of patients with CL/P who underwent orthognathic surgery to evaluate the incidence of subsequent VPI surgery. Subgroup analyses were performed to compare orthognathic surgery type, cleft classification, history of palatal revision surgery, and previous fistula repair. Results: A total of 1626 patients with CL/P who underwent orthognathic surgery, including 1010 single-jaw and 616 double-jaw procedures, were reviewed. A total of 199 (12.24%) patients required subsequent VPI surgery. The incidence was significantly higher in single-jaw compared with double-jaw surgery (15.25% versus 7.31%; P <0.001). CL/P had a significantly greater rate than those with isolated cleft palate (13.30% versus 3.43%; P <0.001). Bilateral CL/P had a higher incidence than unilateral CL/P, but the difference was not significant (16.36% versus 14.02%; P =0.543). Patients with a history of palatal revision surgery had a significantly higher incidence of subsequent VPI surgery (22.83% versus 11.18%; P =0.001). A history of previous fistula repair was associated with a higher incidence, but the difference was not significant (15.83% versus 11.90%; P =0.239). Conclusions: Velopharyngeal insufficiency surgery was performed in ∼1 in 8 patients with CL/P following orthognathic surgery. Single-jaw surgery, CL/P diagnosis, and history of palatal revision surgery are predictors of subsequent VPI surgery. These findings provide important guidance for patient counseling before orthognathic surgery.