Effects of Velar Adhesion Performed with Cheiloplasty on Maxillary Arch Forms in Patients with Unilateral Cleft Lip and Palate

Purpose: Palatoplasty, a surgical procedure for soft palate repair, enables velopharyngeal closure but suppresses maxillary growth. Velar adhesion （VA） refers to the creation of an incision and suturing of the borderline of the oral and nasal mucosa of the soft palate, which reduces the width of the cleft during palatoplasty and facilitates less invasive surgery. In our department, we perform VA during cheiloplasty in patients with unilateral cleft lip and palate （UCLP） and pushback palatoplasty at the age of 1 year and 6 months; however, the effects of VA on maxillary growth remain unclear. In this study, we investigated the effects of VA on maxillary arch forms up to palatoplasty. Furthermore, we determined the duration of use of the feeding obturator and the effects of both on maxillary alveolar arch morphology. <br>Methods: The study included patients with UCLP who underwent pushback palatoplasty at the Saga University Hospital of Oral and Maxillofacial Surgery. We retrospectively recorded age at the time of cheiloplasty and palatoplasty and duration of post-VA feeding obturator use from medical records. Additionally, we measured the maxillary plaster model at 1 year and 6 months of age and confirmed the effects of VA on maxillary arch length, width, and symmetry, as well as alveolar cleft and palatal cleft width. <br>Results: We observed no intergroup difference in age at the time of cheiloplasty and palatoplasty. The mean length of feeding obturator use after cheiloplasty was 12.3 months in the VA （−） group and 5.8 months in the VA （+） group （＜50% of the duration in the VA ［−］ group）. VA did not significantly suppress the length and width of the dental arches. Palatoplasty effectively reduced the width of the alveolar cleft and achieved bilaterally symmetrical alveolar morphology in patients who did and did not undergo VA. The cleft width at the posterior end of the hard palate was significantly reduced to 6.02mm in the VA （+） group. <br>Conclusions: Our study highlights that VA effectively reduces the width of the cleft palate in patients who undergo palatoplasty and enables a less invasive procedure. VA did not inhibit maxillary growth, and we observed symmetrical maxillary alveolar arch morphology at the time of palatoplasty. Future studies are warranted to confirm the long-term effects on maxillary development and on language and occlusal function.