Abstract
Objective: Compare surgical and speech outcomes between the double-opposing Z-plasty (Furlow) palatoplasty vs the 2-flap palatoplasty based on the width of the palatal cleft.
Method: A prospective study of 232 patients with cleft palate repair from April 1995 to March 2010 at a tertiary care institution. The cleft palate was measured (mm) and repaired with a Furlow or 2-flap palatoplasty. Outcome measurements include fistula rate and secondary velopharyngeal insufficiency (VPI) repair.
Results: Primary cleft palate repair was performed on 232 patients by Furlow palatoplasty (n = 96) or 2-flap palatoplasty (n = 136). Patients were subdivided into 4 groups based on width: Group A 1 to 5 mm (n = 57), Group B 6 to 10 mm (n = 38), Group C 11 to 15 mm (n = 72), Group D 16 to 30 mm (n = 4). Fistula rates increase as the width of the palatal cleft increases. Fistula rates are similar between the Furlow and the 2-flap palatoplasty for each palatal width, except for clefts greater than 16mm. Two-flap palatoplasty has a higher rate of velopharyngeal insufficiency for all groups of cleft patients.
Conclusion: At our institution the Furlow and 2-flap methods of palatoplasty have similar fistula rates for all cleft widths; however the Furlow method has decreased risk for subsequent velopharyngeal insufficiency compared with the 2-flap method. These data should encourage performance of the Furlow palatoplasty whenever feasible.
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