Long-Term Midfacial Growth and Speech Outcomes Following Modified Furlow Double-Opposing Z-Palatoplasty

ObjectiveModified Furlow palatoplasty shows favorable early speech results, however long-term outcomes of midfacial growth and speech have not been fully described.DesignA retrospective cohort study was performed of subjects undergoing modified Furlow palatoplasty for primary repair of Veau III and IV cleft lip/palate during a 20-year period. Dentofacial and speech results were analyzed at skeletal maturity using cephalometrics and Pittsburgh Weighted Speech Scores, respectively.ResultsSubjects (n = 186) presented with Veau III (62.9%) and IV (37.1%) clefts. Rates of oronasal fistula (ONF) and velopharyngeal dysfunction (VPD) indicating secondary surgery for speech following palatoplasty were 6.5% and 5.9% in the nonsyndromic cohort. Competent velopharyngeal mechanisms (Pittsburgh Weight Speech Score 0-2) in nonsyndromic subjects were noted in 88.3% postpalatoplasty; resonance deterioration was noted in 5.9% postorthodontic expansion and 14.7% postorthognathic surgery (cumulative VPD 27.8%). At skeletal maturity, 59.2% of nonsyndromic subjects (Veau III 51.4%, Veau IV 74.1%) demonstrated midface hypoplasia according to Steiner analysis and 54.0% ultimately underwent orthognathic surgery (OGS) (III 46.2%, IV 68.4%). Presence of midface hypoplasia correlated with Veau class (P < .003) and presurgical nasoalveolar molding (P < .02). Neither age at repair (P < .90), surgeon (P < 1.0), prior lip adhesion (P < .72), use of vomerine flaps at time of palate repair (P < .33), nor syndromic status (P < .074) correlated with midface hypoplasia. Veau IV clefts demonstrated the highest rate of midface hypoplasia (P < .004).ConclusionsSpeech outcomes in the long term indicate adequate velopharyngeal competency using the modified Furlow palatoplasty. OGS for midface hypoplasia was indicated in over half of patients presenting with severe Veau type cleft phenotypes.