Uvulopalatopharyngoplasty, maxillomandibular advancement, and the velopharynx

Objective: To evaluate the presence of velopharyngeal insufficiency (VPI) s ymptoms and the associated changes of the velopharyngeal anatomy in patient s who underwent maxillomandibular advancement (MMA) for persistent obstruct ive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Methods: Preo perative and postoperative cephalometric radiographs were analyzed to asses s the anatomic changes of the velopharynx. In addition, a questionnaire sur vey was sent to the patients between 6 to 12 months after MMA. The question naires evaluated the presence and extent of VPI symptoms, including nasal r egurgitation while eating or drinking as well as hypernasal speech. A 10-cm visual analog scale (VAS 0-10) was included to assess the impact of VPI sy mptoms on the patient's quality of life. In the patients who reported VPI s ymptoms, telephone interviews were conducted 1 year after the survey to eva luate the changes in VPI symptoms over time. Results: Fifty-two of the 65 q uestionnaires were returned. Five patients (9.6%) reported nasal regurgitat ion of liquids when drinking hastily, with 2 patients reporting the occurre nces as occasional and 3 patients reporting as rare. The impact of these sy mptoms on the patient's quality of life was minimal (VAS 0.6 +/- 0.4). Regu rgitation of food or hypernasal speech was not reported. The telephone inte rviews 1 year later revealed that the symptoms have completely resolved in all 5 patients. Comparison of the preoperative and postoperative cephalomet ric radiographs demonstrated the pharyngeal depth increase was 48% of the a mount of maxillary advancement and the functional pharyngeal length increas ed 53% of the maxillary advancement. The functional depth of the pharynx af ter MMA was significantly greater in the patients with VPI symptoms (P = .0 1), Conclusion: The results of this study suggest that patients who undergo MMA for persistent OSA after UPPP have a low risk of developing VPI. If sy mptoms occur postoperatively, they are mild and have minimal effect on the patient's quality of life; moreover, the symptoms usually resolve over time .