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Review
. 2025 Jul-Aug;15(4):837-848.
doi: 10.1016/j.jobcr.2025.06.001. Epub 2025 Jun 11.

Evaluation of pharyngeal airway changes & velopharyngeal function following Le-fort I osteotomy in cleft lip and palate patients- a systematic review & meta analysis

Eldo Babu  1 , Parvathy Ghosh  1 , K Sarika  1 , Anju James  2 , N K Sapna Varma  1 , V V Ajith  1
Affiliations
Review

Evaluation of pharyngeal airway changes & velopharyngeal function following Le-fort I osteotomy in cleft lip and palate patients- a systematic review & meta analysis

Eldo Babu et al. J Oral Biol Craniofac Res. 2025 Jul-Aug.

Abstract

Background: Le-Fort I osteotomy is commonly performed in cleft lip and palate patients to correct maxillary discrepancies, potentially influencing pharyngeal airway dimensions and velopharyngeal function. Thus, the review aims to evaluate the effects on pharyngeal airway and velopharyngeal function following Le-Fort I osteotomy in cleft lip and palate patients.

Method: This systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive electronic search in databases of Scopus, EBSCO, PubMed, Cochrane, CINAHL, ScienceDirect and Google Scholar was performed to identify studies published from inception to August 2024 with language restricted to English. The critical appraisal using NIH quality assessment tool and data extraction processes were carried out independently by two reviewers. A meta-analysis was conducted to determine the effects of Le-Fort I on nasopharyngeal, oropharyngeal and hypopharyngeal airway depth before and after the intervention. Quality was evaluated using GRADE.

Results: Twelve articles were included in this review. Le-Fort I maxillary advancement significantly increases pharyngeal airway dimensions, particularly in the nasopharyngeal and oropharyngeal regions, with most studies reporting improved airway space postoperatively. However, velopharyngeal function outcomes were variable: some patients experienced transient increases in nasalance or hypernasality, while others showed no significant adverse effects. Notably, preoperative hypernasality may predict postoperative velopharyngeal insufficiency.

Conclusion: Le-Fort I maxillary advancement increases pharyngeal airway volume; particularly in the nasopharyngeal and oropharyngeal regions; thereby improving breathing function, especially during sleep. However, the degree of airway expansion varies depending on the extent of surgery and preoperative airway conditions. While the procedure often enhances velopharyngeal closure by improving anatomical alignment and muscle coordination, it also carries a risk of worsening velopharyngeal insufficiency if the maxilla is advanced beyond a certain limit, which differs among individuals.

Keywords: Cleft lip and palate; Le-fort I osteotomy; Pharyngeal airway; Velopharyngeal insufficiency.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flowchart.
Fig. 2
Fig. 2
Forest plot showing changes in nasopharyngeal airway depth.
Fig. 3
Fig. 3
Forest plot showing changes in oropharyngeal airway depth.
Fig. 4
Fig. 4
Forest plot showing changes in hypopharyngeal airway depth.
Fig. 5
Fig. 5
Summary of findings.
See this image and copyright information in PMC

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