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Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter?
Sean S Evans1, Randall A Bly2, Kaylee Paulsgrove3
1Otolaryngology Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.
Insights
Younger age at cleft palate repair improves speech outcomes and reduces velopharyngeal insufficiency (VPI). Surgery before 13 months is linked to better results in Veau 1 and 2 cleft repairs.
Area of Science:
- Craniofacial surgery
- Pediatric plastic surgery
- Speech-language pathology
Background:
- Cleft palate repair is crucial for speech development.
- Predictors of successful outcomes after palatoplasty require further elucidation.
- Furlow palatoplasty is a common technique for Veau 1 and 2 clefts.
Purpose of the Study:
- To identify predictors of success in Veau 1 and 2 cleft palate repair.
- To analyze the impact of age at surgery and syndromic status on speech outcomes.
- To evaluate the incidence of velopharyngeal insufficiency (VPI) and oronasal fistula.
Main Methods:
- Retrospective review of prospectively collected data from 273 patients.
- Analysis of children under 18 months undergoing Furlow palatoplasty for Veau 1/2 clefts (2000-2014).
- Postoperative perceptual speech assessment (PSA) and multivariate analysis of outcomes.
Main Results:
- Age over 13 months at palatoplasty significantly increased VPI risk (HR, 6.64) and worsened speech outcomes.
- Oronasal fistula occurred in 8.8% of patients, exclusively in Veau 2 clefts.
- Syndromic diagnosis was linked to non-cleft speech errors but not velopharyngeal function post-surgery.
Conclusions:
- Furlow palatoplasty for Veau 1/2 clefts has a 10% VPI rate.
- Palatoplasty before 13 months is associated with significantly better speech outcomes and lower VPI incidence.
- Age at surgery is a critical predictor of success in cleft palate repair.
Objective:
To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes.
Study Design:
Retrospective review of prospectively collected data.
Setting:
Tertiary care children's hospital.
Methods:
All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA).
Results:
In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P < .01), worse speech outcomes (HR, 6.04; P < .01; HR, 1.60; P < .01; HR, 1.57; P = .02), and greater speech therapy utilization (HR, 2.18; P < .01).
Conclusion:
VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty.
