Furlow Double-opposing Z-plasty Research Articles

Preoperative Velopharyngeal Closure Predicts Hypernasality Outcomes of Secondary Furlow Double-Opposing Z-Plasty.

To determine if preoperative velopharyngeal closure percentage (VCP) is predictive of successful Furlow double opposing Z-plasty (DOZP) and subsequently determine the optimal velopharyngeal closure cutoff for successful DOZP. Retrospective study. Tertiary academic center. 110 patients with repaired cleft lip and palate having hypernasality treated with DOZP. Speech videofluoroscopy images were used to obtain the preoperative VCP and other measurements. Changes in hypernasality scores using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification (CAPS-A-AM) rating system were used as the primary outcome measure. A successful DOZP was defined as a postoperative hypernasality score of ≤ 1 or an improvement of 2 or more scores from baseline. A receiver operating characteristic (ROC) curve was calculated to determine preoperative VCP cutoff. There were 110 patients who underwent DOZP for treatment of velopharyngeal insufficiency. Of these patients, 94 (85%) had successful surgery as determined by their postoperative CAPS-A-AM hypernasality score. Preoperative VCP was a statistically significant predictor of successful DOZP (P < .0001). The ROC curve with Youden index (J) determined a cutoff (c*) of 55% preoperative VCP or greater to optimize surgical success rate. Grouping by preoperative VCP showed that surgical success increases directly with preoperative VCP, and patients with low VCP had above a 50% success rate in reducing hypernasality scores. Preoperative VCP was significantly associated with improved hypernasality ratings postoperatively. A preoperative VCP of ≥55% may be used to help predict success of Furlow palatoplasty treatment. Patients with lower VCP can still benefit from secondary DOZP.

Indications for Furlow's double-opposing Z-plasty in patients with velopharyngeal insufficiency following two-flap palatoplasty.

Various surgical methods have been developed for treating velopharyngeal insufficiency (VPI); however, the choice of surgical treatment is controversial. Pharyngeal flap, which is commonly used, has a high success rate but frequently leads to airway complications. Furlow's double-opposing Z-plasty (DOZ) does not deform the velopharyngeal port; therefore, it is expected to show good speech outcomes while reducing airway complications if an appropriate indication is noted. This study aimed to identify indications for DOZ in cases of VPI following palatoplasty. Non-syndromic patients who underwent palatoplasty were prospectively followed from 2008 to 2016, and those diagnosed with VPI were treated with DOZ. Preoperative facial computed tomography (CT) and postoperative nasometric assessment results were examined. Surgical indication was set based on a 30% threshold value for postoperative nasalance. Comparing the preoperative CT parameters of both groups, high Need's ratio (NR), wide width of the nasopharynx (WNP), and long velopharyngeal depth (VPD) were contributing factors to VPI occurrence (p < 0.05). Analyzing preoperative CT and postoperative speech evaluation results, a linear relationship was observed between preoperative NR, WNP, VPD, and postoperative nasalance. In cases where NR < 0.81, WNP < 27.64 mm, and VPD < 20.34 mm, DOZ shows favorable outcomes (p < 0.05). Preoperative CT evaluation should be performed in patients with VPI. When WNP, VPD, and NR values are small, DOZ can achieve sufficient correction of VPI and reduce the risk of airway complications. In cases where the indication range is exceeded, pharyngeal flap is considered.

Impact of palatoplasty techniques on tympanic membrane findings and hearing prognosis in children with cleft palate.

Children with cleft palate (CP) are at high risk of developing otitis media with effusion (OME) due to Eustachian tube (ET) dysfunction. Palatoplasty has been reported to decrease the frequency of middle ear disease and improve ET function, and although various techniques have been developed, there is no consensus on the differences in the impact of different techniques on the middle ear. The purpose of this study was to determine the differential effects of palatoplasty on middle ear function and hearing. We performed a retrospective observational survey of pediatric patients who underwent palatoplasty for CP between June 2010 and October 2018at Tohoku University Hospital. Cases were divided into three groups depending on the palatoplasty procedures performed: the push-back palatoplasty group, the two-flap palatoplasty group, and the Furlow double-opposing Z-plasty group. We examined the differences in clinical characteristics between patients who underwent each procedure. The primary outcome variable was tympanic membrane (TM) findings, and the secondary outcome was hearing test results. Children who underwent the two-flap palatoplasty had a higher tympanostomy tube (TT) insertion rate and a higher total number of TT insertions than those who underwent the Furlow double-opposing Z-plasty or the push-back palatoplasty. The TM retraction rate tended to be lower in the Furlow double-opposing Z-plasty group than in the push-back palatoplasty group or the two-flap palatoplasty group. The hearing test results at the last visit were not significantly different among the three groups. Children who underwent the two-flap palatoplasty had a higher rate of TT insertions, potentially increasing the risk of TM perforation. In contrast, the Furlow double-opposing Z-plasty group had a lower tendency for TM regression, possibly due to improved ET function and reduced incidence of OME. It is important to understand the advantages and disadvantages of each technique before selecting one suitable for the child's cleft and arch width. Additionally, it is important to conduct regular follow-up of TM findings and hearing test results even after palatoplasty.

Two cleft palate simulators of Furlow double-opposing Z- palatoplasty: a comparative study

PurposeThis study aimed to evaluate the efficiency of the porcine tongue for palatoplasty simulation compared to 3D-printed simulators and their surgical education role.Materials and methodsA total of 18 senior cleft surgeons participated in a palatoplasty simulation-based workshop conducted using porcine tongue simulators and 3D-printed simulators. This workshop consisted of a didactic session followed by a hands-on simulation session. Each participant independently used both simulators to perform Furlow double-opposing Z-plasty, which was assessed and scored by senior cleft surgeons using a scoring system including organizational flexibility and ductility, anatomical design simulation, proper incision, proper suturing, and convenience of operation. A paired t test was used for data statistical analysis and a P value < 0.05 was regarded as a statistically significant difference.ResultsAll senior cleft surgeons strongly agreed that the simulation-based workshop was a valuable learning experience, and both simulators were useful and easy to manipulate (P = 1.00). The results of this comparative study showed that a porcine tongue palatoplasty simulator had an effectively significant difference in terms of organizational flexibility and ductility (P = 0.04), and suturing was better than the 3D-printed palatoplasty simulator (P < 0.01). There were no significant differences between the simulators regarding anatomical design simulation (P = 0.76) and incision simulation (P = 0.65).ConclusionBoth porcine tongue simulator and 3D-printed simulator have their unique strengths in surgical education for palatoplasty. Thus, the combined use of a porcine tongue and a 3D-printed cleft palate simulators are efficient as an educational model to practice Furlow double-opposing Z- palatoplasty. The porcine tongue simulators are superior in terms of organizational flexibility, ductility, and suturing simulators, while with the 3D-printed simulator, various palatoplasty techniques can be repeatedly practiced with better-simulated face and oral cavity.

Outcomes of Primary Furlow Double-Opposing Z-plasty for the Treatment of Symptomatic Submucous Cleft Palate.

Submucous cleft palate (SMCP) requires surgical repair if symptomatic. The Furlow double-opposing Z-plasty is the preferred method in Helsinki cleft center. To assess the efficacy and complications of Furlow Z-plasty in the treatment of symptomatic SMCP. This retrospective study reviewed documentation of 40 consecutive patients with symptomatic SMCP who underwent primary Furlow Z-plasty by 2 high-volume cleft surgeons at a single center between 2008 and 2017. Patients underwent perceptual and instrumental evaluation of velopharyngeal function (VPF) by speech pathologists preoperatively and postoperatively. The median age at Furlow Z-plasty was 4.8 years (SD 2.6, range 3.1-13.6). The overall success rate, including postoperative competent or borderline competent VPF, was 83%, and 10% required secondary surgery for residual velopharyngeal insufficiency. The success rate was 85% in nonsyndromic, and 67% in syndromic patients with no significant difference ( P =0.279). Complications arose in only 2 (5%) patients. No children were found to have obstructive sleep apnea postoperatively. Furlow primary Z-plasty is a safe and effective operation for symptomatic SMCP with a success rate of 83% with only 5% rate of complications.

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

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.

Assessment arch dimensions in children with unilateral cleft lip and palate treated surgically by Furlow double-opposing Z-plasty protocol

Objectives: The present study aimed to analyze the outcomes of Furlow double-opposing Z-plasty techniques and to know the effect of this technique on arch dimensions and also to compare these outcomes with the ordinary technique (pushback technique) and with the control group. Materials and Methods: There are two treatment groups and one control group. Forty-two (20 males and 22 females) patients as a total number of the sample with unilateral cleft lip and palate (UCLP) children were included in this study, 1st group (10 males and 14 females) those treated with Furlow double-opposing Z-plasty performed at the age of 10 weeks repair of the lip, at 10 months closure of soft palate followed by construction of obturator done by an orthodontist, at 6 years of patient`s age a closure of hard palate, 2nd group (10 males and 8 females) treated with pushback technique. Criteria for selecting patients (two treatment groups), those without systemic diseases, cerebral disabilities, or any syndromes. The 3rd group consists of 20 healthy children (10 males and 10 females) those free from systemic diseases, aged 9–10 years old, free from oral habits and with limited or no crowding of teeth. Impressions of the upper arch of the patients were taken and the study model was poured at ages 9–10 years. Measurements include anterior arch width (ARW) or intercanine distance, posterior arch width (PAW) or intermolar distance, and arch depth (Adp). Statistical analysis; after collecting the data SPSS software program (version no. 21 Chicago, Illinois, USA) used for analysis, P ≤ 0.05 will be considered as statistically significant. The data were analyzed for their normal distribution, and a comparison of dental arch dimensions between genders and between the two techniques of surgical repair was tested by independent t-test of samples. Results: Significant larger mean values for arch measurements ARW and Adp for males and Adp for females than with the pushback technique. This is related to the growth pattern that occurred without surgical intervention. Conclusion: An improvement in surgical outcomes, and the patients with UCLP treated with Z-plasty technique, revealed an increase in the mean values of arch measurements (anterior and PAW and Adp) for both genders when compared to the pushback technique, but less than that of healthy non-cleft children.

The pilot study of a blended learning module using porcine tongue for surgical simulation of double-opposing Z-plasty.

Simulation course serves as an efficient supplement to the experiential learning inside the operation room in surgical residency programs. Furlow double-opposing Z-plasty (DOZ) remains an important and challenging surgical technique in cleft palate repair, but the simulation is currently limited. This study aims to develop a blended learning module with low-cost and easy-to-promote DOZ simulation. Comparison among the common rodent experimental animals and the readily available porcine tongue was made to select the ideal animal for surgical simulation, with which a DOZ learning module was developed. Oral surgery residents were enrolled to attend the blended learning module. An after-session questionnaire and a quiz were distributed to the participants to collect their feedback of the course perceptions and to assess their learning outcomes. The porcine tongue had more advantages in simulating the human soft palate over the common experimental animals. The surgical procedure of DOZ could be well designed and simulated on the porcine tongue. The vast majority of the participant liked the learning module regarded it as beneficial for the comprehension if DOZ principles and procedures. With the help of the porcine tongue simulator, the blended learning module helped the participants grasp the designing principles of DOZ procedure and promote their associative learning. The blended learning module incorporating the porcine tongue simulator can help oral surgery residents master the principles and procedures of DOZ palatoplasty.

Teaching the Furlow Palatoplasty to Medical Students: A Randomized, Controlled Trial Evaluating a Low-Fidelity Model.

Teaching the Furlow Palatoplasty to Medical Students: A Randomized, Controlled Trial Evaluating a Low-Fidelity Model.

P76. SINGLE Z-PLASTY VERSUS DOUBLE-OPPOSING Z-PLASTY: A COMPARISON OF SUCCESS WITH PALATAL LENGTHENING

PURPOSE: Palate length is associated with improved speech outcomes in cleft palate repair. The Furlow double-opposing Z-plasty (2ZP) utilizes two Z-plasties to reorient palatal musculature and lengthen the velum. An overlapping intravelar veloplasty with a single oral Z-plasty (1ZP) has been described previously. The authors hypothesize that these 2 closure techniques will result in similar palatal lengthening. METHODS: A retrospective comparative study of patients with a cleft palate was conducted. All included patients underwent either 2ZP or 1ZP. Pre- and post-operative measurements of the palate were recorded along various dimensions. The primary outcome of interest was anterior-posterior (AP) palatal length, defined as a straight line measurement from the teeth to the uvula. Analysis was conducted to detect statistical differences using the Mann-Whitney-Wilcoxon test for significance. RESULTS: 80 patients met inclusion criteria (2ZP = 14, 1ZP = 66). Patients who underwent 2ZP exhibited an average increase in palatal length of 7.93mm, and 1ZP was 7.23mm. Both techniques led to a statistically significant increase in palate length. There was no statistically significant difference observed in the change of the AP palatal length by technique (2ZP 16.2% vs 1ZP 15.7%; p = 0.53). CONCLUSION: A single oral Z-plasty results in statistically significant palatal lengthening in patients. There was no difference seen in the AP dimension of palate length comparing 2ZP and 1ZP techniques. production.

Soft Palate Mucosal Adhesion with Muscle Release: An Option in "Wide" Cleft Palates in a Cohort in Southern Africa.

Comparison of speech outcomes in 2 similar groups of "wide" cleft palate. One received a Furlow double-opposing Z- plasty (FZP) versus a group (non-FZP) that received only a muscle release at the second stage after both received a soft palate mucosal adhesion (SPA) at the first stage. Retrospective review. Thirty-three patients (non-FZP) versus 29 patients (FZP) between 2010 and 2016. Both groups had SPA at approximately 6 months of age. After 12 months, an FZP with hard palate closure was performed in the FZP group. in the non-FZP group, only the muscle was released from the posterior palatal shelves with hard palate closure. Speech and velopharyngeal insufficiency (VPi) were determined clinically and by videofluoroscopy. The FZP group (15 M: 14 F) with Veau (III = 14; IV = 5; II = 10) had a mean palate length (MPL) of 20.5 mm and mean palate width (MPW) of 11.2 mm at 8.3 months. MPW decreased to 7 mm after 20.7 months. 21% (n = 6) had fistulae. 14% (n = 4) (all males) had VPI. Their MPL was 16.3 mm. The mean follow-up was 5.5 years. In the non-FZP group, (18 M: 15 F) with Veau (III = 22; IV = 7; II = 4), the MPL was 20.5 mm and MPW was 11 mm at 8.4 months. MPW decreased to 6.5 mm after 12.5 months (P = 0.006). The fistula rate was 18% (n = 6). 24% (n = 8) predominantly male (87%) had VPI (P = 0.432). Their MPL was 17 mm; the mean follow-up was 4.7 years. SPA as a first stage performed in "wide" cleft palate narrows the subsequent hard palate repair and with a muscle release, may be adequate in some patients.

A predictor of a postoperative fistula after double-opposing Z-plasty in bilateral cleft lip and palate patients

Furlow double-opposing Z-plasty (FDOZ) as primary palatoplasty for the bilateral cleft lip and palate (BCLP) closure often leads to a palatal fistula formation in cases with wide clefts. We examined the utility of the calculated maximum closable cleft width to determine the feasibility of a direct palatal closure without lateral incisions. In this retrospective study, we analyzed consecutive patients with a BCLP who were treated for 5 years from 2009. In sixty-three BCLP patients, the following dimensions were measured preoperatively: an actual distance between maxillary tuberosities (Actual X); actual cleft height, calculated from the line joining the maxillary tuberosities to the cleft edge (Actual Y); and actual cleft width at the hard-soft palate junction (Actual Z) and calculated maximum cleft width requiring a direct closure (CMZ). Six months postoperatively, the relationships between the fistula occurrence and actual Z/CMZ were examined. Median values (interquartile range) of Actual X, Y, and Z and CMZ were 35.0 (33.0-39.0) mm, 7.0 (6.0-8.0) mm, 10.0 (8.0-11.0) mm, and 4.6 (2.7-5.7) mm, respectively. The median age at operation was 8.0 (7.0-17.0) months. Fistulae at the hard-soft palate junction developed postoperatively in three cases with more than a 10-mm cleft width (4.76%). A receiver operating characteristic (ROC) curve analysis indicated that actual Z was a better predictor of a postoperative fistula formation than CMZ. An actual cleft width was a better predictor of the fistula occurrence than a calculated maximum cleft width after FDOZ for a BCLP repair. The low fistula rate of FDOZ suggested that FDOZ could be used to close the palate with less than a 10-mm cleft width.

Incidence of fistula after primary cleft palate repair: a 25-year assessment of one surgeon's experience.

BackgroundCleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital.MethodsWe retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients’ medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test.ResultsFistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used.ConclusionsThe overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair.

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

Double-opposing Z-Plasty Extended with a Pedicled Buccal Fat Pad Flap for Correcting Velopharyngeal Insufficiency after Primary Palatoplasty.

Furlow double-opposing Z-plasty (DOZ) lengthens the soft palate; however, this lengthening is achieved at the expense of increased mucosal flap tension. Thus, its use is limited in patients with severe tension applied on mucosal flap after DOZ. In this study, DOZ was combined with a buccal fat pad (BFP) flap to maximize palatal lengthening and muscle repositioning. This study included patients who underwent surgical correction for velopharyngeal insufficiency between December 2016 and February 2019. Patients with more than moderate degree hypernasality following primary palatoplasty were included in the study. Patients younger than 4 years of age, those with a submucous cleft palate, or syndromic patients were excluded. Speech outcomes were investigated for those who underwent DOZ only (DOZ group, n = 17) and those in whom a BFP was used (BFP group, n = 15) pre- and postoperatively. The velopharyngeal gaps between the uvula and pharyngeal wall were measured before and immediately after surgery to estimate the palatal length. Most patients who received a BFP showed improvement in hypernasality. However, the hypernasality of the DOZ group was more severe than that of the BFP group (p = 0.023). The extent of palatal lengthening was 4.4 ± 1.7 mm and 7.5 ± 2.1 mm in the DOZ and BFP groups, respectively (p = 0.001). BFPs reduced the tension of the DOZ mucosal flap and maximized palatal lengthening and muscle repositioning. They promoted velopharyngeal closure in patients with moderate and moderate-to-severe velopharyngeal insufficiency. Hence, our method improves the surgical outcomes of patients with velopharyngeal insufficiency after primary palatoplasty.

Square-root Palatoplasty: Comparing a Novel Modified-Furlow Double-opposing Z-palatoplasty Technique to Traditional Straight-line Repair.

Background:The purpose of this study was to introduce a modification of the Furlow double-opposing Z-plasty (DOZ)—the square-root palatoplasty (SRP)—and critically evaluate outcomes compared to children who underwent straight-line repair (SLR).Methods:A retrospective review was performed of all nonsyndromic children undergoing primary cleft palate closure either by SRP or SLR at our institution between 2009 and 2017. Outcomes of interest included rates/location of oronasal fistula, secondary surgery, speech delay/deficits, resonance, nasal air emission (NAE), articulation errors, and velopharyngeal function. Logistic regression was used to assess for the effect of surgery type on outcomes while controlling for Veau cleft type, age, and gender.Results:Seventy-eight patients were included; 46 (59%) underwent SRP, and 32 (41%) underwent SLR. The mean follow-up was 4.07 years. When compared to SLR, children who underwent SRP were less likely to have oronasal fistula [odds ratio (OR) 4.8, P = 0.0159], speech delay/deficits (OR 7.7, P < 0.001), NAE (OR 9.7, P < 0.001), articulation errors (OR 10.2, P < 0.001), or need for secondary speech surgery (OR 13.2, P < 0.0002). Patients who underwent SRP were also more likely to have normal resonance (78.26% versus 43.75%, respectively; P = 0.0043) and good VP function (84.78% versus 56.25%, respectively; P = 0.0094).Conclusions:This study describes and evaluates outcomes following a modified-Furlow DOZ technique—the SRP. After adjusting for Veau classification, age, and gender in nonsyndromic children, SRP is associated with significantly less speech delay/deficits, NAE, articulation errors, and need for secondary speech surgery when compared to children who underwent SLR.

Optimizing speech outcomes for cleft palate.

Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.

Age and Preoperative Velar Closure Ratio Are Significantly Associated With Surgical Outcome of Furlow Double-Opposing Z-Plasty in Palatal Re-Repair

The patient selection criteria for Furlow double-opposing Z-plasty in palatal re-repair remain obscure. This study investigated whether patients' preoperative characteristics significantly affected the surgical outcome of Furlow double-opposing Z-plasty in palatal re-repair. We designed and implemented a case-control study nested in a cohort, which could be divided into 2 stages. In the first stage, a retrospective cohort study was performed to collect basic information and the preoperative status of the patients who would undergo Furlow double-opposing Z-plasty to correct velopharyngeal insufficiency after primary cleft palate repair. Eight predictor variables were included: age, gender, primary surgical technique, velopharyngeal closure pattern, velar movement, lateral pharyngeal wall movement, levator muscle orientation, and preoperative velar closure ratio. The outcome variable was postoperative velopharyngeal function described as velopharyngeal competence or velopharyngeal insufficiency. In the second stage, a case-control analysis was performed to explore the potential factors affecting the surgical outcome. Univariate and multivariate analyses were applied to examine the relationship between the predictor variables and surgical outcome. The sample was composed of 83 patients and resulted in 54 velopharyngeal competence outcomes and 29 velopharyngeal insufficiency outcomes after surgery. Two predictors showed statistical significance: age and preoperative velar closure ratio. The possibility of postoperative velopharyngeal insufficiency in patients older than 14.5years was 6 times higher than that in patients younger than 14.5years. The possibility of postoperative velopharyngeal insufficiency in patients with preoperative velar closure ratios of 0.9 or greater was one fifth that in patients with preoperative velar closure ratios between 0.8 and less than 0.9. The results of this study suggest that age and preoperative velar closure ratio are significantly associated with postoperative velopharyngeal insufficiency. Age was a risk factor in achieving good surgical outcomes, and the preoperative velar closure ratio remained a protective factor.

Does the Children's Hospital of Philadelphia Modification Improve the Fistula Rate in Furlow Double-Opposing Z-Plasty?

Oronasal fistulas (ONFs) have been the most common complication of primary cleft palatoplasty. The present study evaluated the incidence of ONFs after primary standard Furlow and modified Furlow palatoplasty and a buccal fat pad flap (BFPF) as a viable tissue layer to facilitate wound healing. A retrospective cohort study was conducted. The data from all the patients who had met the criteria for primary palatoplasty from 2003 to 2016 and had undergone surgery by a single surgeon were retrospectively reviewed from an established cleft databank. An initial group of patients (2003 to 2007; standard Furlow palatoplasty) and a subsequent group (2008 to 2016; modified Furlow palatoplasty), all of whom had received the BFPF, were evaluated. The primary outcome variable was the development of palatal fistula. An additional outcome predictor included single versus staged palatoplasty. A χ2 analysis using a 1-tailed Fisher exact test was used, with statistical significance established at P≤.05 to determine the difference in ONF development using different operative techniques. A total of 49 patients had undergone standard Furlow palatoplasty, with an ONF rate of 22.4%. Of the 49 patients, 28 had had isolated cleft palate (ICP; 6 ONFs), 12 had had unilateral cleft lip/palate (UCLP; 2 ONFs), 9 had had bilateral cleft lip/palate (BCLP; 3 ONFs). A total of 65 patients had undergone modified Furlow palatoplasty with a BFPF, with a total ONF rate of 3%. Of the 65 patients, 40 had had ICP (1 ONF), 18 had had UCLP, and 7 had had BCLP (1 ONF). This difference in the ONF rate was statistically significant (P=.0015). The staged repairs resulted in an ONF rate (22.6%) that was significantly greater (P=.029) than the rate with nonstaged repairs (7.1%). The occurrence of ONFs tended to be greater in the patients with BCLP, syndromic patients, after staged repairs, and patients with wide cleft defects. A reduced ONF rate appeared to be associated with the modified Furlow palatoplasty and single-stage palatoplasty. Among the cleft types, BCLP showed a tendency to an increased postoperative ONF rate.

Analysis of Arch Widths in Patients With Isolated Pierre Robin Sequence.

To compare arch widths of patients with isolated Robin sequence (IRS) operated using modified von Langenbeck technique and modified Furlow double-opposing z-plasty. Retrospective, transversal study. Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. Three groups of patients were analyzed. Group VL comprised 30 patients with IRS operated by von Langenbeck technique (mean age of 8.1 years); group FL included 30 patients with IRS operated by Furlow technique (7.6 years); and the control group included 30 noncleft patients with class I occlusion (7.4 years). The palate repair was performed between 1.0 and 1.7 years of age in both study groups. Transversal measurements of maxillary and mandibular arches were performed digitally on 3D digital models. The intergroup comparison was performed using analysis of variance and Tukey test. An independent t test was used to compare the complete and incomplete types of cleft in both study groups. The level of significance was 5%. No statistically significant difference was found between the VL and FL groups for maxillary and mandibular arches. However, both groups showed decreased transversal dimensions compared with the control group (P < .01) for both dental arches. No differences for arch widths were observed for complete or incomplete palatal clefts. No influence of palate repair techniques was observed in the transversal arch widths in patients with IRS. Children with IRS operated for palate repair showed constriction of the maxillary and mandibular dental arches compared with noncleft children regardless the palatal cleft extension.