D23. Quarter Century Review of Velopharyngeal Insufficiency Rates between Palatoplasty Techniques among Patients with Robin Sequence

Abstract

PURPOSE: Children with Robin sequence (RS) have wide U-shaped cleft palates. Following primary palatoplasty, RS patients have high rates of velopharyngeal insufficiency (VPI), often requiring speech-correcting surgery. This study compares VPI rates between palatoplasty techniques among the RS population. METHODS: A retrospective review of patients with isolated RS without concomitant syndromes from 1997-2022 was completed. Clinical and operative data were collected. Surgical techniques were performed by multiple senior surgeons and were categorized as Furlow double-opposing Z-plasty or straight-line palatoplasty. The primary outcome is surgical VPI rates. RESULTS: Upon review, 91 patients were identified to have isolated RS, of which 79 had a concomitant cleft palate. Overall surgical VPI rate was 11.4%. Follow-up time was 6.3±4.8 years (Furlow) and 4.2±4.0 years (straight-line; p=0.0593). Excluding patients with less than two years of follow-up, 35.7% (15/42) of Furlow patients had clinically diagnosed VPI compared to 11.8% (2/17) of the straight-line cohort (p=0.066). No patients in the straight-line cohort required speech-correcting surgery. The Furlow cohort had higher surgical VPI rates (21.4% vs. 0.0%; p=0.038) compared to straight-line. Upon Kaplan-Meier analysis, the 5-year surgical VPI rate was 11.6% and 0.0% for the Furlow and straight-line cohorts, respectively (p= 0.066). CONCLUSION: Our findings suggest the Furlow technique resulted in higher surgical VPI rates than straight-line repair among our RS patients. Though the Furlow technique offers palatal lengthening, this technique may compromise velum function in this wide cleft RS population.