Furlow Palatoplasty: Should We Also Focus on the Size of the Nasopharynx?

Leclerc, Jacinthe; Gilbert, Francis; McConnell, Élisa-Maude; Beaudoin, Ericka; Bouchard, Johanie; Simonyan, David

doi:10.1177/1055665620987684

Cited by 4 publications

(2 citation statements)

References 41 publications

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“…20 Its effect on the FP outcome in correction of overt cleft palate or secondary VPI has been proven by numerous studies but is inconclusive among the SMCP population. 6,20,29,60,65,66 In this study, preoperative VCR was not indicated as predictive of FP outcome.…”

Section: Discussioncontrasting

confidence: 58%

Prognostic Factors for Speech Outcome among Patients with Submucous Cleft Palate Managed by Furlow Palatoplasty or Posterior Pharyngeal flap

Zhang

Shi

Zheng

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Submucous cleft palate (SMCP) is a particular subtype of cleft deformity for which the optimal surgical timing and technique are still under debate. This study aimed to identify potential prognostic factors for the speech outcome of patients with SMCP and provide evidence for further management strategy optimization. Methods: The authors reviewed patients with nonsyndromic SMCP who received either Furlow palatoplasty (FP) or posterior pharyngeal flap (PPF) between 2008 and 2021 in a tertiary hospital–based cleft center. Both univariate and multivariate logistic regression models were used to screen preoperative variables, including cleft type (overt or occult), age at surgery, mobility of velum and pharyngeal wall, velopharyngeal closure ratio, and pattern. The receiver operating characteristic curve was used to determine the cutoff value of the significant predictors for subgroup comparison. Results: A total of 131 patients were enrolled, with 92 receiving FP and 39 receiving PPF. Age at operation and cleft type were identified as having significant effects on FP outcome. Patients operated on before 9.5 years of age had a significantly higher velopharyngeal competence (VPC) rate than those operated on after that age. The speech outcome among patients with occult SMCP was significantly worse than that of patients with overt SMCP after FP treatment. No preoperative variable was found to be correlated with PPF outcome. PPF yielded a higher VPC rate than did FP among patients operated on after 9.5 years of age. Conclusions: The prognosis of patients with SMCP treated with FP is sensitive to age at surgery and cleft type. PPF may be considered for older patients in settings with limited access to multiple surgical procedures, especially when occult SMCP is diagnosed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Section: Discussioncontrasting

confidence: 58%

Prognostic Factors for Speech Outcome among Patients with Submucous Cleft Palate Managed by Furlow Palatoplasty or Posterior Pharyngeal flap

Zhang

Shi

Zheng

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Nevertheless, we can fi nd many comparison studies dealing with late complications such as velopharyngeal insuffi ciency (VFI), orofacial fi stula or decreased growth of maxilla (18,19). In the past 5 years , there has been an increased number of articles dealing with other factors affecting long-term surgical results such as size of the nasopharynx and age of children undergoing palatoplasty (20,21). The reviews are comparing usually two different procedures from the most frequent palatoplasty approaches (according to von Langenbeck, Veau-Wardill-Kilner and double opposite reverse Z-palatoplasty according to Furlow).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of patients after different types of secondary cleft palate repair

Gabrielova¹,

Macho²,

Fedeleś³

et al. 2022

BLL

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The aim of this retrospective study was to evaluate results of four different surgical approaches to palatoplasty and to demonstrate which type showed the lowest number of cases with the need for secondary surgeries. The results of 227 patients who underwent cleft palate surgical repair over a 13-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) were included. The incidence rates of oronasal fi stula, velopharyngeal insuffi ciency with the need of pharyngeal fl ap and pharyngoplasty were examined. The need for revision surgery was found in 48 patients (21.1 %). A signifi cantly higher rate of cases with the need for secondary correction was found in patients with a complete cleft (44 %) as compared to patients with incomplete cleft palate (9.8 %). A higher percentage for additional surgery was noted after the Bardach procedure (50 %) as opposed to the lower revision rate after Veau-Wardill-Kilner (22.8 %) and Furlow (17.6 %). After the von Langenbeck procedure, the need for revision eventuated only in 5.5 % of cases. It is important to mention that there were no signifi cant differences in the incidence of secondary surgery between the patients with cleft palate with or without the presence of Pierre Robin sequence. Neither there was observed a signifi cant difference in the incidence of additional surgery between male and female patients. However, a higher need for pharyngeal fl ap was noted in the female group (Tab. 8, Ref. 38).

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