American Association of Plastic Surgeons

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Outcomes of Furlow Double Opposing Z-plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study
Jack E. Brooker, MD1, Michael R. Bykowski, MD1, James J. Cray, PhD2, Matthew D. Ford, MS CCC-LP3, Lorelei Grunwaldt, MD1, Alexander Davit, MD1, Jesse A. Goldstein, MD1, Joseph E. Losee, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Ohio State University, Columbus, OH, USA, 3UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

PURPOSE: The submucous cleft palate (SMCP) can be overt or occult (OSMCP). The double-opposing z-plasty (Furlow) is our centerís preferred approach to surgical repair. This study sought to: 1) evaluate the complication rates, 2) describe differences in outcome between overt and occult SMCP patients, 3) describe other features (e.g. age or preoperative VP function as measured by the Pittsburgh Weighted Speech Score (PWSS)), associated with surgical failure.
METHODS: Electronic records of patients undergoing Furlow palatoplasty for SMCP at our center were retrospectively analysed.
RESULTS: 351 patients were included, 126 with overt SMCP and 225 with OSMCP. Mean follow-up: 2.1 years. Mean preoperative PWSS was 14.6 vs mean postoperative PWSS of 5.2 (p<0.001). Patients with OSMCP were older at palatoplasty than overt (7.5 vs 6.5 years, p=0.001) with lower preop PWSS (14.1 vs 15.7, p=0.035). Postoperative PWSS were similar for both. Furlow palatoplasty was successful (postoperative PWSS less than 7 without recommendation for secondary speech surgery (SSS)) in 291 (82.1%) of patients. Patients requiring SSS had a preoperative PWSS of 16.9 vs 14.2 for those not (p=0.005). Age at palatoplasty and SMCP type were not predictive of the need for SSS. V-shaped velar vaulting on preoperative assessment was present in 92% of OSMCP patients. There were no documented complications of palatoplasty.
CONCLUSION: Furlow palatoplasty is a safe and effective for SMCP. Patients with OSMCP presented later with a lower PWSS on average. High preoperative PWSS was associated with the need for SSS. V-shaped velar vaulting is reliable sign of OSMCP.


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