Speech Outcomes At Facial Maturity And Secondary Speech Surgery Rates Following Modified Furlow Palatoplasty
Connor S. Wagner, BS1, Carlos E. Barrero, BS1, Zachary D. Valenzuela, BS1, Lauren K. Salinero, BS1, Matthew E. Pontell, MD1, Susan M. McCormack, MA CCC-SLP1, Cynthia Solot, MA CCC-SLP1, Marilyn Cohen, BA LSLP1, Richard E. Kirschner, MD2, David W. Low, MD1, Oksana Jackson, MD1.
1Division of Plastic, Reconstructive, and Oral Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA, 2Department of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH, USA.
PURPOSE:
Following modified-Furlow palatoplasty, patients may demonstrate velopharyngeal dysfunction necessitating secondary speech surgery. However, speech outcomes at skeletal maturity and the incidence of speech surgery by this age remain under-reported. This study updates our institutional experience with modified-Furlow palatoplasty to report speech outcomes at completion of facial growth.
METHODS:
Nonsyndromic patients undergoing palatoplasty from 1980-2005 with follow-up at 15 years of age were reviewed for history of speech surgery and Pittsburgh Weighted Speech Scale assessments and compared to historical data published for the same cohort. Incidence of speech surgery and speech scores were assessed across all patients as well as by Veau type, age at palatoplasty, gender, race, and time period of repair.
RESULTS:
Three hundred sixty-four patients underwent palatoplasty in the study period and met inclusion with 15-year follow-up (average follow-up 17.5±4.6 years). Age at palatoplasty was 11.9±9.1 months. Seventy-two (19.8%) patients underwent secondary speech surgery at 11.7±4.1 years. Veau types 1 and 2 predicted need for speech surgery compared to types 3 and 4 (p < 0.001). No other factors were predictive (p > 0.05). 167 patients without prior speech surgery had speech assessments beyond 15 years of age, 77% of whom had a competent-borderline competent velopharyngeal mechanism. There was no association between speech scores and any measured factor (p > 0.05).
CONCLUSION:
When followed to skeletal maturity after modified-Furlow palatoplasty, the incidence of secondary speech surgery is higher than previous reports with shorter follow up. Veau types 1 and 2 may be susceptible to poorer speech outcomes.
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