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Incidence of Secondary Surgery after Modified Furlow Palatoplasty: A 20-Year Single-Surgeon Case Series
Stephen R Chorney1, Emily Commesso1, Sherard Tatum1
11 SUNY Upstate University Department of Otolaryngology and Communication Sciences, Syracuse, New York, USA.
Insights
The modified Furlow technique for cleft palate repair showed acceptable rates for velopharyngeal insufficiency (VPI) surgery. However, oronasal fistula repair rates were high, potentially due to limited use of relaxing incisions.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Plastic Surgery
Background:
- Velopharyngeal insufficiency (VPI) and oronasal fistulas are common complications following primary palatoplasty.
- The Furlow technique is a widely used method for cleft palate repair, but its outcomes regarding secondary surgeries require ongoing evaluation.
Purpose of the Study:
- To assess the incidence of VPI requiring pharyngeal flap surgery and oronasal fistula repair after primary palatoplasty using a modified Furlow technique.
- To identify factors associated with the need for secondary interventions in patients undergoing primary palatoplasty.
Main Methods:
- A retrospective case series involving chart review of children under 18 who underwent primary palatoplasty by a single surgeon.
- Data collected included demographics, cleft type, genetic syndromes, surgical procedures, and complications such as VPI and oronasal fistulas.
- The modified Furlow technique was performed in the majority of cases (92.6%).
Main Results:
- Out of 312 patients, 5.1% required pharyngeal flap surgery for VPI and 15.4% needed oronasal fistula repair.
- Veau class II clefts had higher rates of pharyngeal flap surgery (P = .033).
- Oronasal fistula repair rates were lower in Veau class I but higher in Veau classes II and IV. Older age and Robin sequence were associated with increased fistula repair rates.
Conclusions:
- The modified Furlow palatoplasty demonstrates acceptable rates for secondary VPI surgery without cleft width selection.
- The observed high rate of oronasal fistula repair is consistent with prior studies and may be linked to the infrequent use of lateral relaxing incisions.
Abstract:
Objective To determine the occurrence of velopharyngeal insufficiency (VPI) requiring surgery and fistula repair after primary palatoplasty using a "modified" Furlow technique. Study Design Case series with chart review. Setting Academic multidisciplinary cleft and craniofacial center. Subjects and Methods Children younger than 18 years at presentation, with unrepaired cleft palate, with or without cleft lip, including submucous clefts, who underwent palatoplasty were included. No cleft patients having primary repair were excluded. All operations were conducted by a single surgeon from March 1994 through December 2013. Charts were reviewed for demographics, cleft type, genetic syndrome, operations performed, and complications, including VPI and oronasal fistula. Results In total, 312 consecutive patients underwent primary palatoplasty (160 [51.3%] male) with a median age of repair of 0.95 (range, 0.47-17.6) years and followed for 6.49 (range, 4.0-20.2) years. Robin sequence was diagnosed in 109 (34.9%), 104 (33.4%) had alveolar clefts, and 27 (8.7%) had concomitant gingivoperiosteoplasty. A modified Furlow was performed in 289 (92.6%). Overall, 16 (5.1%) required subsequent pharyngeal flap for VPI, and 48 (15.4%) required oronasal fistula repair. Veau class II had higher pharyngeal flap rates ( P = .033). Fistula repair was lower in Veau I ( P < .001) but higher in Veau II ( P < .001) and IV ( P = .002). Older age ( P = .034) and Robin sequence ( P = .017) were associated with higher rates of oronasal fistula repair. Conclusions The modified Furlow palatoplasty yields acceptable rates of secondary surgery for VPI without selection based on cleft width. While our oronasal fistula repair rate is high, it is concordant with previous reports and is likely related to our rare use of lateral relaxing incisions.
