<< Back to the abstract archive
Improving Speech Outcomes After Failed Primary Palate Repair: Evaluating the Safety and Efficacy of Conversion Furlow Palatoplasty
Harry S Nayar, B.A.; James J. Cray, PhD, Zoe M. MacIsaac, M.D.; Anne E. Argenta, MD; Mathew D. Ford, MS; Regina A. Fenton, MSN; Joseph E. Losee, MD; Lorelei J. Grunwaldt, MD
Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center
2012-02-14
Presenter: Harry Nayar
Affidavit:
I certify that this study is the original work of the listed authors and has never been published previously.
Director Name: Joseph E. Losee (joseph.losee@chp.edu)
Author Category: Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
The provision of normal speech is the goal of the craniofacial surgeon in repairing the cleft palate, however this goal remains unmet in a nontrivial amount of cases following primary repair. One option for secondary management, pharyngoplasty, is effective but exposes the patient to the established long-term morbidity of obstructive sleep apnea. The option we are studying, the conversion Furlow palatoplasy, avoids this morbidity and addresses speech in a safe and efficacious manner. Thus, our inquiry into the Conversion Furlow Palatoplasty could shift the management paradigm to one that better serves these young patients.
How will your presentation be used by practicing physicians in the audience?
It is our hope that the information contained within our study will be used to augment and guide clinical decision-making for the Craniofacial surgeons in the audience, and possibly add another tool to their armamentarium for addressing the failed cleft repair.
Background: Comprehensible speech is the paramount goal of cleft palate surgery. Straight-line repair with intravelar veloplasty does not consistently transpose the entire levator muscle and risks postoperative velopharyngeal insufficiency (VPI). In contrast, Furlow palatoplasty allows palatal lengthening and repositioning of the levator muscle. We hypothesize that a conversion Furlow palatoplasty (CFP) may allow for long-term correction of VPI that resulted from failed primary repair, obviating the need for pharyngoplasty and its attendant morbidities.
Methods: A retrospective review of patients undergoing CFP between 2003-10 was performed at our cleft center. Patients were grouped by primary palatal procedure: straight-line repair (n=48), straight–line with subsequent oronasal fistula (n=18), or pharyngeal flap (n=18). Degree of VPI was assessed using Pittsburgh Weighted Speech Scores (PWSS) (competent ≤2, borderline 3-6, incompetent ≥7). Scores were compared preoperatively and postoperatively at 3 sequential visits, and analyzed using Friedman's test and Post Hoc Tukey Nemenyi.
Results: Eighty-four patients were reviewed, of which 77% (n=65) had data points commiserate with analysis. Median PWS scores at individual visits were: pre-op=11, 1st postop=3, 2nd postop=1, and most recent postop=3. There was a significant difference between preoperative and postoperative PWS scores in the entire cohort (p< 0.001) with overall improvement, and post hoc analysis showed improvement between each of the postoperative visits (p<0.05) but not between the postoperative scores of the operative subgroupings (P>0.05). Twelve patients failed to improve and showed no significant difference in PWSS over time.
Conclusions: CFP is an effective means of salvaging speech after failed primary palate repair.
