Facial growth following pharyngeal flap surgery: skeletal assessment on serial lateral cephalometric radiographs.

The purpose of this study was to evaluate the effect of pharyngeal flap surgery on subsequent facial growth in patients with cleft lip and/or palate. Pharyngeal flap surgery is used in such patients to partially obliterate the velopharyngeal port, reducing hypernasal speech. Thirty-four patients (18 with cleft palate only, 16 with unilateral cleft lip and palate) were selected from the longitudinal growth study of the H.K. Cooper Clinic. Seventeen of these (9 with cleft palate only, 8 with unilateral cleft lip and palate) underwent pharyngeal flap surgery between the ages of 5 and 7 years. The other seventeen patients did not undergo pharyngeal flap surgery and served as a control group for this study. Serial lateral cephalometric radiographs were traced and digitized (ages 3 to 5, preflap; ages 7-10, postflap). Fourteen skeletodental measurements (six angular, six linear, two derived) were taken to determine whether pharyngeal flap surgery may be related to subsequent facial growth changes. The data from the 17 flap patients were compared with control data taken from the other seventeen patients. The groups were matched for sex, cleft type, and similarity of presurgical mandibular growth direction (facial axis angle). Results obtained demonstrate several significant areas of change following flap surgery, including a decrease in facial axis angle, an increase in Frankfort-mandibular plane angle, an increase in incremental gains in lower anterior face height, and increased retroclination of upper and lower incisors in the flap group as compared to their matched controls.