Repair of submucous cleft palate with Furlow palatoplasty

Submucous Cleft Palate: A Systematic Review of Surgical Management Based on Perceptual and Instrumental Analysis

“…Two studies measured preoperative and postoperative nasalance (Abdel-Aziz et al, 2012; Bezuhly et al, 2012). Bezuhly et al (2012) demonstrated normal postoperative nasalance in 78% (n = 61/78) of patients following either Furlow Z-palatoplasty or pharyngeal flap surgery.…”

“…There is, however, controversy regarding which procedure results in the optimal outcome (Gosain et al, 1996; Nasser et al, 2008). Proponents of palate reconstruction suggest that normalizing the primary anatomic abnormality is the logical first step in improving velopharyngeal function (Pensler et al, 1988; Chen et al, 1996; Sommerlad et al, 2004; Abdel-Aziz et al, 2012). The theoretical advantage of this management strategy is that it does not compromise the integrity of the airway and if hypernasality persists, pharyngeal surgery can still be undertaken at a later date (Sommerlad et al, 2004; Sullivan et al, 2011).…”

Timing of Furlow Palatoplasty for Patients With Submucous Cleft Palate

“…However, emerging data demonstrate higher rates of obstructive sleep apnea (OSA) in the postoperative period following both pharyngeal flap and dynamic sphincter pharyngoplasty (Ettinger et al, 2012; Jackson et al, 1976; Kravath et al, 1980; Orr et al, 1987; Sirois et al, 1994; Thurston et al, 1980; Valnicek et al, 1994; Ysunza et al, 1993), prompting surgeons to consider Furlow palatoplasty as a primary treatment for submucous cleft palate. Furlow palatoplasty has been shown to be an effective treatment for symptomatic velopharyngeal dysfunction in patients with submucous cleft palate without the increase in airway obstruction seen with other techniques (Abdel-Aziz et al, 2012; Chen et al, 1996). The ability to anatomically reposition the aberrantly inserted levator veli palatini muscles and simultaneously lengthening the posterior soft palate makes the Furlow palatoplasty an appealing primary intervention to address velopharyngeal dysfunction while leaving the option for other techniques to be used in refractory cases.…”

“…Nevertheless, the optimal timing of palatoplasty repair in the submucous cleft palate population remains unknown. The recommended age of palate repair in the submucous cleft palate population varies widely in the literature, from 7 months to 26 years (Abdel-Aziz et al, 2012; Chen et al, 1996; Park et al, 2000; Pensler and Bauer, 1988; Sommerlad et al, 2004; Sullivan et al, 2011; Ysunza et al, 2001). Although a subset of older patients may represent those who presented late in adulthood, the wide age range denotes an overall lack of agreement on the optimal timing of palate repair.…”

Effects of Surgical Intervention and Continuous Positive Airway Pressure Therapy on Velopharyngeal Structure and Function: A Case Report

“…Although reports vary across studies, an estimated 33% of patients with SMCP who receive palatoplasty will require a secondary surgery to address residual hypernasality caused by VPD (Sullivan et al, 2011). Surgical outcome studies in patients with SMCP and residual VPD are largely based on perceptual speech assessments and do not quantify the impact of muscular changes in vivo on postsurgical speech and resonance ratings (Seagle et al, 1999; Husein et al, 2004; Sullivan et al, 2011; Abdel-Aziz et al, 2012; Argenta et al, 2013; Jackson et al, 2013; Ng et al, 2015; Nguyen et al, 2015; Pet et al, 2015).…”