Changes in speech following maxillary distraction osteogenesis.

OBJECTIVE: The purpose of this study was to describe changes in articulation and velopharyngeal function following maxillary distraction osteogenesis.

DESIGN: This is a descriptive, post hoc clinical report comparing the performance of patients before and after maxillary distraction. The independent variable was maxillary distraction while the dependent variables were resonance, articulation errors, and velopharyngeal function.

SETTING: The data were collected at a tertiary health care center in Chicago.

PATIENTS: The data from pre- and postoperative evaluations of 18 maxillary distraction patients were used.

OUTCOME MEASURES: The outcome measures were severity of hypernasality and hyponasality, velopharyngeal orifice size as estimated using the pressure-flow technique, and number and type of articulation errors.

RESULTS: At the long-term follow-up, 16.7% exhibited a significant increase in hypernasality. Seventy-five percent of patients with preoperative hyponasality experienced improved nasal resonance. Articulation improved in 67% of patients by the 1-year follow-up.

CONCLUSIONS: In a predominately cleft palate population, the risk for velopharyngeal insufficiency following maxillary distraction is similar to the risk observed in Le Fort I maxillary advancement. Patients being considered for maxillary distraction surgery should receive pre- and postoperative speech evaluations and be counseled about risks for changes in their speech.