The Sommerlad–Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors

Abstract

Objective To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad–Furlow modified palatoplasty technique. Study Design Retrospective cohort. Methods A total of 429 patients with cleft palate, who received Sommerlad–Furlow modified technique between 2011–2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected. Results Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42–4) years, and the average cleft width was 10.15 ± 2.95 (4–27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p = 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p ˂ 0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve = 0.611, p = 0.002) was the cutoff value for predicting the incidence of VPI. Conclusions The Sommerlad–Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes. Level of Evidence 4 Laryngoscope, 133:822–829, 2023

Dental caries and periodontitis risk factors in cleft lip and palate patients

“…However, some related technologies are still in their infancy and need further improvement and optimization ( 68 ). Some postoperative complications such as hypoplastic maxilla, concaved mid-face, deformed dental arch and oronasal fistula are common and difficult to completely circumvent after surgery ( 54 , 69 ). Oronasal fistula occurs because of the poor wound healing after surgical repair and the overall incidence varied greatly from 0 to 77.8% ( 21 ).…”

Updates in Cleft Care

“…Average incidence is 3 to 4%, but incidences reported in the literature range from 0 to 34% and depend on surgeon and type of repair. 94 104 107 110 Cleft palate width is a risk factor for postoperative palatal fistula; defects larger than 15 mm have a higher incidence of postoperative fistula formation. 133 The Pittsburgh Fistula Classification Scale is commonly used to describe palatal fistulas and is based on the anatomic location ( Fig.…”

“…Both of these techniques can be combined with z-plasty closure and are effective in addressing wide palatal clefts with significantly lower rates of fistula formation, middle ear dysfunction, and VPD. [108][109][110] One of the newest modifications to the intravelar veloplasty is the overlapping intravelar veloplasty. 111 This technique involves separation of the levator muscles down to skull base, with overlapping and tightening of the levator sling.…”

Obturator Manufacturing for Oronasal Fistula after Cleft Palate Repair: A Review from Handicraft to the Application of Digital Techniques

“…The primary purpose of the ONF obturator is to obstruct abnormal communication between the oral and nasal cavities. However, in patients with cleft palate, velopharyngeal insufficiency (VPI) can also be the cause of speech problems and affect their quality of life [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Both ONF and VPI can contribute to the speech dysfunction of the patient [ 49 , 50 , 51 ], so both aspects should be considered during the manufacture of the obturator.…”