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Longitudinal Evaluation of Velopharyngeal Function After Furlow Palatoplasty for Occult Submucous Cleft Palate: An Analysis of Early and Late Surgical Failures
Michael R. Bykowski, Jack E. Brooker, Matthew D. Ford, Alexander J. Davi, Lorelei J. Grunwaldt, Jesse A. Goldstein, Joseph E. Losee
University of Pittsburgh
2019-02-18
Presenter: Michael R. Bykowski
Affidavit:
The majority of work presented represents the work by the submitting resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION
Furlow palatoplasty reliably treats velopharyngeal insufficiency (VPI) in many patients with Occult Submucous Cleft Palate (OSMCP), but long-term outcomes are unclear. The objectives are to serially track long-term speech outcomes of OSMCP following Furlow palatoplasty and to determine risk factors.
METHODS
We present a retrospective analysis of patients with OSMCP-related VPI who underwent Furlow palatoplasty (2004 – 2016). Perceptual speech evaluations were performed by a speech pathologist using the Pittsburgh Weighted Speech Scale (PWSS). Surgical failure was defined as PWSS ≥7 (VPI) and recommendation for secondary speech surgery.
RESULTS
Mean age and follow-up =7.4 and 3.3 years, respectively (n=124 patients). Three groups of patients were characterized based on when postoperatively they met criteria for surgical failure: (1) "Early failure"= 0.33–0.75 years (11.3%); (2) "Late Failures">1 year (8.1%); and (3) "Success"= never (80.6%). VCFS, hypotonia, and prior adenoidectomy had residual hypernasality and surgical failure (all p's<0.05 vs. "Success"). Patients with Developmental Delay (DD) had worse articulation scores vs. non-DD patients (3.4 vs 1.7; p<0.05) but no difference in hypernasality scores (1.3 vs. 1.0).
CONCLUSIONS
The postoperative survival probability of patients without identified risk factors was 98.2% at 3 years and 88.4% at 5 years, suggesting that Furlow palatoplasty effectively treats VPI. Multiple factors predispose to "Early" surgical failure and residual hypernasality: VCFS, hypotonia, and prior adenoidectomy – all of which affect the velopharyngeal port. DD patients had good palatal function (low nasality scores) but poor articulation scores and failed late likely related to inability to adapt to their corrected velopharyngeal apparatus.
