The Children’s Hospital of Philadelphia Modification of the Furlow Double-Opposing Z-Palatoplasty

Abstract

The authors' 30-year experience with the modified Furlow palatoplasty shows stable speech results, decreasing rates of secondary surgery, and an acceptable rate of postoperative oronasal fistula.

Long term speech outcomes following late cleft palate repair using the modified Furlow technique

“…The experience at our institution documents a higher incidence of VPI in late cleft palate repairs performed at greater than 18 months of age (p = 0.024) [21]. In this population, there was also a higher rate of persistent articulation errors associated with VPI (p = 0.0001).…”

“…Early cleft palate repair has, therefore, been advocated to minimize maladaptive speech development, as compensatory strategies to regulate airflow through the oropharynx may develop in the presence of a cleft [2][3][4]. Late cleft repair, after these compensatory mechanisms are learned, leads to documented worse speech outcomes and higher rates of secondary surgery for velopharyngeal insufficiency [21].…”

“…It is well known that late cleft repair leads to documented worse speech outcomes and higher rates of secondary surgery for VPI [1,2,4,21]. A study from our institution reported significantly worse overall speech scores using the Pittsburgh Weighted Values for Speech Symptoms Associated with VPI in patients who underwent palatoplasty at greater than 18 months of age compared to those who underwent repair at earlier ages (p = 0.025) [21].…”

“…A study from our institution reported significantly worse overall speech scores using the Pittsburgh Weighted Values for Speech Symptoms Associated with VPI in patients who underwent palatoplasty at greater than 18 months of age compared to those who underwent repair at earlier ages (p = 0.025) [21]. There was a significantly higher incidence of velopharyngeal insufficiency in the late repair population when compared to those repaired at earlier ages (p = 0.024).…”

Discussion

“…Also, the study outcomes represent an early time point (3 years). Long-term outcomes with palatoplasty have demonstrated some deterioration of velopharyngeal function over time, 6,10,11 and the discussants are eager to see the authors' outcomes with greater numbers and longer followup, because, in the end, "there is little disagreement that the primary objective for the surgical repair of palatal clefts is the subsequent development of normal speech" 6 ; and surgeons should promote outcome data rather than procedures.…”