Sunday, October 10, 2004 - 2:10 PM

Clinical Outcomes of the Furlow Z-plasty for Primary Cleft Palate Repair

Rohit K. Khosla, MD, Ziv M. Peled, MD, Charles L. Castiglione, MD, and Kelly Mabry, PhD, CCC/SLP.

The most effective technique for cleft palate repair continues to be a topic of debate. Many previous studies have suggested superior speech results with the Furlow Z-plasty. We retrospectively reviewed the clinical outcomes in a large series of primary Furlow palatoplasties performed by a single surgeon. Outcomes of 140 patients who underwent palate repair are presented here. Speech evaluations were performed to score the severity of hypernasality, nasal escape, misarticulation, and velopharyngeal insufficiency (VPI). The mean age at latest evaluation was 4 years and 9 months old. Overall, no or mild VPI was diagnosed in 97.9% of patients. No or mild hypernasality was observed in 97.2% of patients. No or mild nasal escape was seen in 98.4% of patients. No or mild misarticulation was observed in 93.6% of patients. Secondary posterior pharyngeal flap to correct VPI was required in only 1.43% of patients. The formation of an oro-nasal fistula occurred in only 2.17% of patients. We found that patients with a diagnosis of a genetic syndrome or Robin sequence did just as well as non-syndromic patients in terms of VPI, hypernasality, and nasal escape. Syndromic patients were more likely to make mild to moderate articulation errors. We also found that age at palate repair, cleft type, and surgeon experience had no statistically significant effect on speech results. The Furlow Z-plasty yielded excellent speech results in our patient population, with minimal and acceptable rates of fistula formation, velopharyngeal dysfunction and the need for additional corrective surgery.
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