Incidence of Secondary Surgery after Modified Furlow Palatoplasty: A 20‐Year Single‐Surgeon Case Series

Abstract

Objective To determine the occurrence of velopharyngeal insufficiency (VPI) requiring surgery and fistula repair after primary palatoplasty using a "modified" Furlow technique. Study Design Case series with chart review. Setting Academic multidisciplinary cleft and craniofacial center. Subjects and Methods Children younger than 18 years at presentation, with unrepaired cleft palate, with or without cleft lip, including submucous clefts, who underwent palatoplasty were included. No cleft patients having primary repair were excluded. All operations were conducted by a single surgeon from March 1994 through December 2013. Charts were reviewed for demographics, cleft type, genetic syndrome, operations performed, and complications, including VPI and oronasal fistula. Results In total, 312 consecutive patients underwent primary palatoplasty (160 [51.3%] male) with a median age of repair of 0.95 (range, 0.47-17.6) years and followed for 6.49 (range, 4.0-20.2) years. Robin sequence was diagnosed in 109 (34.9%), 104 (33.4%) had alveolar clefts, and 27 (8.7%) had concomitant gingivoperiosteoplasty. A modified Furlow was performed in 289 (92.6%). Overall, 16 (5.1%) required subsequent pharyngeal flap for VPI, and 48 (15.4%) required oronasal fistula repair. Veau class II had higher pharyngeal flap rates ( P = .033). Fistula repair was lower in Veau I ( P < .001) but higher in Veau II ( P < .001) and IV ( P = .002). Older age ( P = .034) and Robin sequence ( P = .017) were associated with higher rates of oronasal fistula repair. Conclusions The modified Furlow palatoplasty yields acceptable rates of secondary surgery for VPI without selection based on cleft width. While our oronasal fistula repair rate is high, it is concordant with previous reports and is likely related to our rare use of lateral relaxing incisions.

Low incidence of maxillary hypoplasia in isolated cleft palate

“…This may imply that scaring from the initial palatoplasty and subsequent procedures does not affect maxillary growth restriction. Although many authors have focused on the relationship between surgical technique of the initial palatoplasty and maxillary growth [19][20][21][22][23], we believe technical nuances such as raising mucoperiosteal flaps or vomerine flaps may not alter the maxillary growth trajectory. Patient age at the time of repair also did not seem to have an effect either.…”

“…Interestingly, a higher rate of secondary procedures has been reported after cleft palate closure in patients with ICP. As Chorney et al noted in their case series of 312 patients, patients with Veau type 2 have a statistically higher rate of pharyngeal flap requirement and oronasal fistula repair [21]. Similarly, in their study of 869 non-syndromic cleft palate patients, Jackson et al found that patients with ICP had the worst speech outcomes and higher rates of secondary surgery for velopharyngeal dysfunction [19].…”

Revision Surgery of the Cleft Palate

“…The rate of VPI following primary palate repair requiring secondary surgery ranges from 5 to 29%. [44][45][46] There are a variety of factors that must be considered when reporting the incidence of VPI in cleft patients. First, there is currently no standardized assessment for diagnosing and rating the severity of VPI.…”

The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis

“…2015; Lin et al, 2015;Moar et al, 2016;Yuan et al, 2016;Chorney et al, 2017;Li et al, 2017). Of the 6 articles that remained, 3 were excluded because of overlapping data with other articles.…”