Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil.

ABSTRACT

OBJECTIVE: To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. DESIGN: Retrospective study. SETTING: Tertiary level craniofacial hospital. PARTICIPANTS: 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. INTERVENTIONS: Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. MAIN OUTCOME MEASURES: Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. RESULTS: After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). CONCLUSIONS: Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.