Furlow Technique Research Articles

The Furlow Z-plasty in two-staged palatal repair modifications and complications

Objectives To report the modifications and complications of the Furlow palatoplasty for two-stage closure of the palate. Patients and methods Prospective study of a consecutive series of 45 primary closures of the soft palate portion of clefts extending into the hard palate; mean (S.D.) age at repair 12 (2) months; median follow-up 4 years 4 months (range 2 months to 9 years). The hard palatal part of the cleft was closed in 18 patients at the mean age of 3 years 11 months. Results The main modifications that we made were the use of quilting sutures, lateral V– Y closures, and fibrin glue application, and the omission of lateral releasing incisions. Patients stayed in hospital for a median of 4 days (range 3–8 days). Two patients had postoperative partial obstruction of the airway and were given steroids. In six patients, a smaller portion of the oral layer of the wound broke down; it healed by secondary intention in five, but resulted in partial dehiscence in one. There were no oronasal fistulas in the 18 patients who had delayed closure of the hard palate part of the cleft. Secondary pharyngoplasty was not necessary in any patient. Conclusion Furlow's technique has been modified for use in the two-stage closure of complete cleft palates (with or without cleft lip or alveolus) with an acceptable rate of complications.

Early maxillary growth in complete cleft lip, alveolus and palate patients following Widmaier-Perko's, or a modified Furlow's technique of soft palate repair

Introduction: The aim was to study the differences in early maxillary growth following the use of two techniques for soft palate repair in complete cleft lip, alveolus and palate patients. Material and methods: Out of sixty-four primary soft palate repairs, two model samples (one of each) having been matched (gender, age, cleft type, maxillary anterior and posterior width at time of soft palate repair) were selected from the groups treated according either to Furlow or to Widmaier-Perko. The Wilcoxon Test for small samples was used to test for differences. Results: At the age of 4 years, posterior transverse cleft size was significantly smaller by 2.26 mm on average (SD 2.23) in the Furlow sample. The posterior maxillary segment had grown sagitally 1.5 mm (SD 0.76) more in the Furlow sample. At the age of 4 years, all other parameters, including inter-canine point and inter-tuberosity distances did not significantly differ between the two samples. Conclusion: Transverse posterior growth was not statistically different between the samples and seemed to be within normal limits in both. There was more sagittal growth in the posterior maxillary segment in the Furlow sample, possibly related to less fibrotic contracture in the posterior hard palate and the soft palate. The transverse posterior cleft size was more reduced in the Furlow sample. This could not be correlated with the techniques chosen to close the hard palate cleft at the age of 4 years.

Cleft palate repair at 3 to 7 months of age.

We report the speech outcome in 90 children with complete unilateral cleft lip and palate who underwent soft palate repair either between 3 and 7 months of age (n = 40) or later than 7 months of age (n = 50). In all patients, palatoplasty was performed by one of two experienced surgeons using a modification of the Furlow technique, and speech evaluations were conducted using the Pittsburgh Weighted Values for Speech Symptoms Associated with Velopharyngeal Incompetence by two speech pathologists with high inter-rater reliability. There were no differences between the groups with respect to resonance, nasal air emission, and articulation. Velopharyngeal function, as measured by the total speech score, was similar between the two groups of patients, as were the rates of secondary pharyngoplasty. These results suggest that very early closure of the soft palate may not offer significant benefit over repair later in infancy with respect to speech outcome.

Bilateral buccal flaps with double opposing Z-plasty for wider palatal clefts.

Described is a technique that has evolved from the challenges of closure of larger cleft palate defects and that we are now using in preference over other techniques to repair a wide variety of clefts. Soft-palate closure and muscular sling reconstruction are accomplished using a modified Furlow technique. An associated cleft of the hard palate and the gaps produced by posterior displacement of the reconstructed soft palate are closed by adding tissue, buccal flaps, rather than by closure under tension or leaving residual raw surfaces. Palate lengthening is achieved both by the Z-plasty effect and by the interposition of buccal flaps between the hard and soft palate. Seventy-six palates have been repaired using this procedure. There were three postoperative fistulas.

Cleft palate repair: Furlow versus von Langenbeck

The Furlow cleft palate repair using a double opposing Z-plasty appears to be very promising. In order to detect advantages and disadvantages concerning the technique as well as speech- and hearing results, the Furlow palatoplasty was compared with the classical von Langenbeck technique. Data analysis from 10 children in both groups revealed that the Furlow technique proved to be superior to the von Langenbeck technique as far as speech sound is concerned: at a mean age of 3.5 years, nasality and nasal escape were absent in almost all cases. However, there were no significant differences between the techniques in respect of articulatory skills, language comprehension, language production as well as hearing. Technically, the Furlow technique is more difficult to perform, particularly in wide clefts.

Incidence of Palatal Fistula after One-Stage Palatoplasty and Factors Influencing the Fistula Occurrence

Background: Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas are related to an increased rate of hypernasal speech, articulation problems, and food or liquid regurgitation from the nose. Fistulas also tend to recur after a secondary repair to address the fistulas. This study reviews the rate of fistula in our craniofacial center after a onestage cleft palate repair; and to determine whether, cleft type, age at repair, type of cleft repair, hemoglobin level presurgery, and patients nutritional state influence the risk of fistula occurence.
 Patient and Method: A retrospective analysis was performed on medical records of 93 patients who underwent palate repair between January 2012 to October 2013. All consecutive cleft (lip and) palate patients are included. Bivariate analysis was performed to identify the predictors of fistula formation.
 Result: Ninety-three patients (50 male and 43 female) underwent one-stage palatoplasty. Cleft palate fistulas occured in 19 of 93 patients (20,4%). The age of the patients at the time of repair ranged from 9 to 144 months (mode 18 months). All palate repairs were done in one stage, using either the two flap (N=66), Wardill-Kilner (N=24), Furlow (N=2), and Langenback (N=1) techniques. No significant influence was found related between age at the time of repair (p 0.789), body weight (p 0.725), Hemoglobin value (p 0.295), and type of cleft (p 0.249) to the rate of fistula occurrence.
 Summary: This study found no association between , body weight, preoperative hemoglobin value, and the type of cleft to the rate of fistula following cleft palate surgery.