Long-term Follow-up Of A Prospective Randomized Trial Of Cleft Palate Repairs, Comparing The Intravelar-veloplasty And The Double-opposing Z-plasty.
Michael T. Friel, MD1, Angela J. Dixon, MA, CCC-SLP2, Robert J. Havlik, MD3.
1Ochsner Hospital for Children, New Orleans, LA, USA, 2Riley Hospital for Children - IU Health, Indianapolis, IN, USA, 3Medical College of Wisconsin, Milwaukee, WI, USA.
PURPOSE: There has not been a long-term outcome study of a prospective, randomized study comparing Intravelar veloplasty (IVV) and the Furlow palate repair. We report the first long-term outcome study of a prospective, randomized study evaluating the two palate repairs.
METHODS: A prospective trial comparing the two palate repairs from 1998 through 2005 was conducted. After the child was placed under anesthesia, and a coin toss was performed to determine if the child was to be placed in the Furlow or IVV group.
A total of 76 patients were enrolled, and 58 had long-term follow-up. The overall average follow-up was 9.3 years for the 58 patients, with each group having 29 patients. In the Furlow group, there was one post-operative fistula. Twenty-three (of 29) patients demonstrated no hypernasality or audible nasal air emission, and no patients in this group underwent secondary speech surgery. In the IVV group, there were five post-operative fistulas. Three patients underwent conversion to a Furlow after the patients demonstrated VPI and seven patients underwent pharyngeal flaps. Sixteen (of 29) had normal resonance and no audible nasal air emission. Of the ten patients that had undergone secondary speech surgery, two continued to have speech symptoms suggestive of VPI.
This is the first reported prospective, randomized trial with long-term outcomes comparing the Furlow palatoplasty to the Intravelar Veloplasty. In this study, we show the Furlow palatoplasty to be more effective repair method for children with a cleft palate.
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