An Exploratory Analysis of Early Care Differences and Risk of Post-Maxillary Advancement VPI in Individuals With Cleft Palate

Objective To investigate whether differences in early cleft care increase risk of velopharyngeal insufficiency (VPI) after maxillary advancement. Design Retrospective cohort study. Setting Large pediatric tertiary care hospital. Patients/Participants Adolescents and young adults (AYAs) with cleft palate (-/+ cleft lip) who underwent maxillary advancement between 2008 and 2019. Interventions/Comparisons Initial palate repair at a different institution (early care elsewhere, ECE) versus care at a single institution (consistent care, CC). Main Outcome Measures Post-maxillary advancement VPI. Results One-hundred seventy-eight AYAs underwent maxillary advancement, 74 in the ECE group and 104 in the CC group. The ECE group was more likely to be internationally adopted (34% versus 4%), to have a history of VPI surgery (54% versus 32%) and to be older at time of palate repair (mean 25 versus 16 months). Of anatomical measures, only velar length differed, with the ECE group tending to have a shorter velum (mean 26 mm versus 28 mm). Proportional odds regression revealed increased odds of post-operative VPI in the ECE group (OR 1.46, 95% CI 0.75-2.85) relative to the CC group. This relationship was stronger among those with bilateral cleft lip and palate (OR 3.29, 95% CI 0.86-13.52). For patients with history of prior VPI surgery, the odds of post-operative VPI in the ECE group was more than 3 times that in the CC group (OR 3.06, 95% CI 1.08-9.16). Conclusions VPI after maxillary advancement is more likely among individuals who received early cleft care elsewhere compared to those who underwent all cleft operations at a single center.