Outcomes and Predictive Factors of Furlow Palatoplasty

Objective 1) Describe patients with submucous cleft palates (SMCP) and velopharyngeal insufficiency (VPI) treated with furlow palatoplasty who later required subsequent surgery due to persistent VPI. 2) Identify risk factors predictive of revision surgery in SMCP patients in order to develop a clinical algorithm to apriori determine the most efficacious primary surgery based on preoperative evaluation. Method A retrospective review of 14 patients with SMCP undergoing furlow palatoplasty to correct VPI. Data reviewed included need for secondary surgery, syndrome diagnosis, velopharyngeal closure, and preoperative speech evaluations. Results A series of 14 patients having furlow palatoplasty between ages 3 and 16 (average age of 4.9 years) was identified. Three of these patients (21.4 %) required secondary correction of VPI via superiorly based pharyngeal flap an average of 2.3 years following the initial operation. There was no association between age at primary surgery or syndromic diagnosis and persistent VPI. Predictors of persistent VPI after palatoplasty were poor preoperative speech ( P <. 03) and nasometry scores ( P <. 09). Pattern of velopharyngeal closure was not predictive of further surgery, however an association between larger velopharyngeal gap and need for revision surgery was found. Conclusion Preoperative speech and nasal endoscopic assessment of patients with SMCP and VPI is predictive of patients who require palatoplasty alone or may benefit from primary velopharyngeal surgery.