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Superior Outcome with Modified-Furlow Repair compared to Straight Line Palatoplasty
Shoichiro A. Tanaka, MD, MPH
Ananth S. Murthy, MD
Summa Health, Akron, OH
2019-02-10
Presenter: Shoichiro A Tanaka, MD
Affidavit:
This projects represents the original work of the presenting resident. It is a collaboration between him and the senior author, as designated below.
Director Name: Douglas Wagner, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: At our institution, straight line repair had an increased need for secondary speech surgery. Modifications included lengthening the palate with a modified-Furlow and using an acellular-dermal matrix spacer to mitigate scarring at the hard-soft junction. Our hypothesis was that these modifications would lead to better outcomes after palatoplasty.
Methods: An IRB-approved retrospective review was performed of a prospectively collected database of all cleft palate patients who underwent palatoplasty by the senior author between 2010 - 2016. Exclusion criteria included loss of follow up, syndromic diagnosis, or Robin sequence. Variables reviewed included demographic data, Veau classification, surgical technique, fistula, speech analysis, and need for secondary speech surgery.
Results: A total of 136 patients were operated in that time frame. Of those, 58 were excluded resulting in 78 patients for review. Thirty-two (41%) patients underwent straight line repair and 46 (59%) underwent modified-Furlow repair. Veau 3 clefts were the most common between the two groups. Between straight line and modified-Furlow, fistula occured in 31.25% and 8.7% (p-value = 0.016), of which 7 and 1 patient needed repairs, respectively. Between straight and modified-Furlow, 56% and 85% had normal VP function (p-value <0.0001). Of these, secondary speech surgery was required in 12 patients (37.5%) and 2 patients (4.35%), respectively (p-value = 0.0002).
Conclusion: At our center, modified-Furlow palatoplasty is superior to straight line repair with decreased fistula rates and need for secondary speech surgery. By reviewing our data, we can optimize care for our patients with cleft palate.
