Comparison of Speech Outcomes Following Furlow Z-Plasty Versus Pharyngeal Flap in the Primary Management of Submucous Cleft Palate

Abstract

Objective

To evaluate comparative speech and surgical outcomes of Furlow Z-plasty (FZP) versus pharyngeal flap (P Flap) in the primary treatment of submucous cleft palate (SMCP).

Design

Systematic review and meta-analysis.

Setting

PubMed, Embase, MEDLINE, Scopus, and CENTRAL were systematically searched from database inception through June 2025.

Patients/Participants

Eight nonrandomized studies including 376 pediatric patients with SMCP (FZP: n = 250; P Flap: n = 126).

Interventions

Primary surgical treatment with FZP or P Flap.

Main Outcomes and Measures

The primary outcomes evaluated were postoperative residual hypernasality (perceptually assessed), velopharyngeal insufficiency (VPI), and reoperation rates. Secondary outcomes included obstructive sleep apnea (OSA) and oronasal fistula formation.

Results

There was no significant difference in residual hypernasality scores between the 2 interventions (odds ratio [OR] 0.88; 95% confidence interval [CI] [0.41-1.92]; P = .757). However, patients undergoing FZP had significantly higher odds of persistent postoperative VPI (OR 2.36; 95% CI [1.14-4.88]; P = .020) and reoperation (OR 3.16; 95% CI [1.21-8.22]; P = .019). Conversely, FZP was associated with a slightly lower risk of OSA (OR 0.11; 95% CI [0.01-1.06]; P = .056). No difference in postoperative fistula formation was observed between the 2 procedures (OR 1.13; 95% CI [0.11-11.61]; P = .920).

Conclusions

Based on the available evidence, P Flap appears to offer more durable speech outcomes than FZP for the primary treatment of SMCP, with significantly lower reoperation rates. However, the potential for increased OSA risk following P Flap highlights the importance of patient-specific surgical planning that balances velopharyngeal function with airway safety.