Speech Outcomes After Secondary Furlow Z-Plasty and Pharyngeal Flap Procedure

The optimal surgical approach for treating velopharyngeal insufficiency (VPI) in patients with cleft is unknown. Hence, the authors reported the outcomes and success rates of the Furlow Z-plasty and pharyngeal flap procedures for treating VPI in all types of clefts. The authors included 377 patients in this study, of whom 351 and 26 underwent Furlow Z-plasty and the pharyngeal flap procedures, respectively. The authors retrospectively assessed the outcomes of both procedures in 3 groups: the nonsyndromic, Robin sequence (RS), and syndromic groups. All patients were evaluated by speech pathologists preoperatively and postoperatively. The success rate of VPI correction after Furlow Z-plasty was 82%; however, 12% required a reoperation for residual VPI. Patients in the syndromic group had significantly higher VPI rates than their nonsyndromic counterparts ( P <0.001). The success rate was 81% after the pharyngeal flap procedure; however, 8% of patients required a second operation for residual VPI. The postoperative VPF of patients in the nonsyndromic and RS groups did not significantly differ compared with the syndromic group ( P =0.782). Some patients (12%) developed obstructive sleep apnea (OSA) after the pharyngeal flap procedure; however, none developed it after the Furlow Z-plasty. The median hospital length of stay after the pharyngeal flap procedure was prolonged compared with that after the Furlow Z-plasty ( P <0.001). Both procedures were effective in correcting VPI. Children in the syndromic group had an increased rate of VPI after Furlow Z-plasty. Development of OSA and prolonged hospital stay were observed after the pharyngeal flap procedure.