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Superior Outcome with Modified-Furlow Repair Compared to Straight Line Palatoplasty – a Matched Cohort Study
Shoichiro A. Tanaka, MD
Ananth S. Murthy, MD
Summa Health System, Akron, OH
2020-02-15
Presenter: Shoichiro A. Tanaka, MD
Affidavit:
I certify that this project represents the original work of the resident.
Director Name: Douglas Wagner, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
At our institution, straight line repair was noted to carry an increased need for secondary speech surgery. Modifications included lengthening the palate with a double-opposing z-plasty (modified-Furlow) in addition to the use of an acellular-dermal matrix spacer to mitigate scarring at the hard-soft junction. Our hypothesis is that these modifications will lead to better outcomes after palatoplasty.
Methods:
This is an IRB-approved retrospective review of all cleft palate patients who underwent palatoplasty by the senior author between 2010 – 2016. Exclusion criteria include loss of follow up, syndromic diagnosis, or Robin sequence. Surgical technique was either straight line or modified-Furlow repair. Patients were gathered consecutively until groups were matched. Variables reviewed include age, sex, Veau classification, fistula, and presence of hypernasality.
Results:
A total of 136 patients were operated on in that time frame. Of those, 58 were excluded due to syndromic diagnosis (35), inadequate speech data (4), or Robin sequence (19), resulting in 78 patients for review. Twenty-five (51%) patients underwent straight line repair and 24 (49%) underwent modified-Furlow repair. Veau 3 clefts were the most common between both groups. Between straight line and modified-Furlow, fistula was found in 5 patients (25%) and 4 patients (27%), respectively (p-value = 0.91), and hypernasality was identified in 12 patients (50%) and 2 patients (10%), respectively (p-value 0.003).
Conclusion:
At our center, modified-Furlow palatoplasty is superior to straight line repair with decreased rates of hypernasality and equivalent rates of fistula. By reviewing our data, we optimize care for our cleft palate patients.
