A Comparison of the Effects of Veau-Wardill-Kilner Palatoplasty and Furlow Double-Opposing Z-Plasty Operations on Eustachian Tube Function

Does Palatal Muscle Reconstruction Affect the Functional Outcome of Cleft Palate Surgery?

“…Eustachian tube dysfunction and impaired active dilatation has been found in 100 percent of the cleft palate patients who have not undergone operation. 9 The benefits of palatal muscle reconstruction in cleft palate patients can be assessed in several ways, including improvement in eustachian tube function and speech, the number of patients requiring further surgery (i.e., pharyngoplasty), and the morbidity of surgery, both primary (i.e., palatal repair) and secondary (i.e., pharyngoplasty). 9 Although the mean age in our study was 22.5 months, which was equal to the current usual practice, 18,19 we think that an earlier age at surgery could yield greater functional improvement with intravelar veloplasty.…”

“…Our policy was not to start any conservative treatment or to place a grommet tube before surgery because of our belief that this abnormality is attributable to cleft palate, which should be repaired in advance of any treatment for eustachian tube dysfunction. 9 In addition, we treated postoperative secretory otitis media conservatively for a maximum period of 6 months, which was our limit to place a grommet tube, to give a chance for (17) Volume 119, Number 6 • Palatal Muscle Reconstruction spontaneous resolution of the secretory otitis media. [22][23][24] Although no statistically significant differences were found, the current study revealed resolution of secretory otitis media in the first 6 months postoperatively in 13 percent of patients in group A (Veau class II) and 18 percent of patients in group B (Veau class I) in the three-layer palatoplasty group but in only 5.5 percent of cases in group B in the two-layer palatoplasty group.…”

“…Therefore, frequent myringotomy and tympanostomy tube placement is usually required. 8,9 Recent studies have highlighted the importance of palatal muscle reconstruction to improve eustachian tube function in cleft palate patients. 10 The objectives of cleft palate surgery are to close the palate to restore normal function to eating and drinking and to enhance the development of normal speech and eustachian tube aeration of the middle ear and facial growth.…”

“…WardillKilner V-Y pushback palatoplasty is a modification of the von Langenbeck technique to release palatal length for improved function in which release at the anterior aspect of the von Langenbeck incision is performed. 9 Furlow palatoplasty (double-reversing Zplasty) is a procedure for soft palate only, in which two Z-plasties, one on the oral mucosa and one on the nasal mucosa, are sutured with reversed orientation. 11 Kriens palatoplasty involves modification of the Wardill-Kilner V-Y pushback technique, in which submucosal dissection of the muscles on the nasal side and then reconstruction of the palatal muscles in the midline and three-layer closure are performed.…”

Die Gaumenplastik nach Furlow – Erfahrungen an 114 konsekutiven Fällen

“…Die Furlow-Methode wurde bisher in retrospektiven Vergleichen gegenüber der intravelaren Plastik mit Muskelorientierung [8], der Wardill-KilnerOperation [1] oder anderen Lappentechniken [7,21] bewertet. Auch die in der vorgelegten Untersuchung gebildete Kontrollgruppe leidet unter fehlender Randomisierung, unterscheidet sich insbesondere aber durch ein höheres Alter bei Primäroperation und der Nachuntersuchung.…”