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Objective The Furlow palatoplasty is a proven procedure in the management of secondary velopharyngeal dysfunction in patients with cleft palate. But the selection of cases, the degree of clinical success, and the preoperative predictors of the same are less established. This study is an effort to retrospectively look at outcomes, in a large series of velopharyngeal dysfunction cases treated with the Furlow palatoplasty alone. Design Retrospective analysis of preoperative and postoperative speech and videofluoroscopic data. Setting Tertiary care center. Patients/Participants Ninety-two patients who were diagnosed with velopharyngeal dysfunction post primary cleft palate repair. Interventions Furlow palatoplasty for velopharyngeal dysfunction post primary cleft palate repair. Main outcome measures Variables analyzed were perceptual speech parameters and, closure ratios obtained from lateral video-fluoroscopic images. Results Overall, 81.5% had postoperative improvements in their lateral video-fluoroscopic parameters, 63% improved their nasality scores, and 65.2% had improved speech intelligibility. A simple linear regression was done to predict the postoperative closure ratio. Preoperative closure ratio, hypernasality (moderate and severe), and audible nasal air emission are predictors for postoperative closure ratio. Conclusions The Furlow palatoplasty alone led to complete resolution, or significant improvement of velopharyngeal dysfunction in a majority of patients, despite the cohort having a wide range of severity in terms of degree of dysfunction. The predictive formula will be validated in a further study.

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Nasoalveolar molding (NAM) has been glorified and maligned. Supporters argue that NAM improves cleft outcomes and reduces secondary procedures. Critics highlight the expense, labor intensity, and inconsistent or transient results. We offer NAM to our patients and have been doing so for over a decade; nevertheless, our benefits assessments are nuanced. In the following paper, we present our rationale, evolution, technique, and outcomes of NAM, augmented with an analysis of the literature. We offer another perspective in this ever-evolving area of evidence-based cleft palate care.