Correction of Secondary Velopharyngeal Insufficiency in Cleft Palate Patients with the Furlow Palatoplasty

Influence of preoperative velar closing ratio and lateral wall movement on outcomes of Furlow palatoplasty for velopharyngeal incompetence

“…However, patients with worse preoperative LWM exhibited better resolution of nasal emissions. While we had expected that patients with a poor preoperative VCR would demonstrate greater improvement in speech postoperatively, we also expected that those with poor preoperative LWM would not do as well postoperatively because residual lateral velopharyngeal gaps would presumably be present (3,5). Our data suggest that that assumption may be incorrect.…”

“…Chen et al (3) found that preoperative LWM >0.375 mm was an independent indicator of surgical success; however, they did not correlate this with resting port width nor investigate VCR. Gossain et al (5) stated that gap size and LWM should be considered concurrently to determine the appropriate procedure.…”

“…Chen et al (3) examined both forms of measurement in a study involving 18 patients with postpalatoplasty VPI and found that double-opposing Z-plasty had the most success in alleviating VPI in patients with a 'gap size' <5 mm, and hypothesized that the maximum gap size appropriate for double-opposing Z-plasty is between 5 mm and 10 mm. In terms of velar displacement, Chen et al (3) reported their best results in alleviating VPI in patients with VCR >75%. Perkins et al (4) also extensively studied gap size as an indicator of surgical success.…”

“…While many studies have reported that poor LWM is associated with poor surgical outcomes with double-opposing Z-plasty, those studies focused on absolute measurements of LWM and AP diameter (3,5). To our knowledge, no study has previously investigated LWM as a fraction of approximation to the midline in conjunction with VCRs.…”

Ressonância de fala e complicações cirúrgicas após palatoplastia primária com veloplastia intravelar em pacientes com fissura de lábio e palato

“…Para tanto, realiza-se a dissecção ampliada dos músculos do palato mole, o que significa que os mesmos são completamente liberados da margem óssea do palato duro, separados das mucosas nasal e oral e unidos na linha média como uma cinta muscular, numa posição mais posterior. Por tratar-se de um procedimento de reposicionamento muscular, a veloplastia intravelar pode ser incorporada às técnicas convencionais utilizadas na palatoplastia primária (CHEN et al, 1994;PERKINS et al, 2005;NOORCHASHM et al, 2006). (SOMMERLAD et al, 1994;2002;SOMMERLAD, 2003;2008 infecções sistêmicas no período pós-operatório, tosse, vômitos ou febre, dentre outras, podem alterar o processo natural de cicatrização do palato recém-operado.…”