Comparative Evaluation of Modified Furlow Palatoplasty and Intravelar Veloplasty in Cleft Palate Repair
Abstract
Introduction: The purpose of this study was to comparatively assess the two techniques of cleft palate repair i.e. Kriens intravelar veloplasty (IVV) and modified Furlow Palatoplasty (MFP) for post-operative fistula formation, wound dehiscence at suture line, nasal regurgitation, velopharyngeal insufficiency, soft palate lengthening and speech.
Method: This prospective study was conducted on 60 patients having primary cleft palate. They were assigned either to IVV group or MFP group randomly so that both the groups consisted of 30 patients each. The two groups were operated under general anesthesia. Measurements at the time of operation were made with the help of soft ruler and Castroviejo caliper. Follow up of patient's was done 1 week, 1 month, 3 month, 6 months and complication is present was noted. Five year post operatively speech was recorded and assessed by the speech language pathologist. Post-operative Nasoendoscopy was also performed to assess the velopharyngeal insufficiency.
Result: The MFP group showed more percentage elongation of the soft palate and less incidence of post-operative palatal fistula formation than IVV group. Total speech scores were superior in MFP patients but the differences were less robust. Velopharyngeal incompetence was present in both groups but was less severe in MFP group than the IVV group.
Conclusion: The MFP group showed comparatively superior results than the IVV group but required an increased surgical time. Therefore MFP can be used as an alternative technique for cleft palate repair.Keywords
References
Furlow LT. cleft palate repair: preliminary report on lengthening and muscle transposition z- plasty. Presented at annual meeting of the southeastern society of plastic and reconstructive surgeons. Boca, Raton , may 16, 1978
Furlow LT. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg. 1986, 78(6):724-736
Kriens O. An anatomical approach to veloplasty. Plast Reconstr Surg. 1969,43:29
Kernahan DA, Stark RB. A new classification for cleft lip and cleft palate. Plast Reconstr Surg. 1958,22:435-441.
Havlik R. Total release double opposing z-plasty of cleft palate closure. Presented at the annual meeting of the ohio valley society of plastic surgeons. Indian apolis. 2003
Carstens MH. sequencial cleft management with the sliding sulcus technique and alveolar extension palatoplasty. J Craniofac Surg. 1999, 10:503-518
Bindingnavele VK, Bresnick SD, Urata MM, Huang G, Leland HA, Wong D, Hammoudeh J, Reinisch J. Superior results using the islandized hemipalatal flap in palatoplasty: experience with 500 cases. Plast Reconstr Surg. 2008, 122:232-239
Millard DR. alveolar and palatal deformities. Cleft craft: the evolution of its surgery. Vol 3, Boston: Little, Brown and Company. 1980
Schultz RC. Management and timing of cleft palate fistula repair. Plast Reconstr Surg. 1986, 78:739-747
Amaratunga NA. Occurrence of oronasal fistulas in operated cleft palate patients. J Oral Maxillofac Surg. 1988, 46:834-838
Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft Palate fistulas: a multivariate statistical analysis of prevalence, etiology and surgical management. Plast Reconstr Surg. 1991, 87:1041-1047
Furlow LT. The double opposing z-plasty for palate closure. Part 1 In: Jackson IT, Sommerland BC. eds. Recent advances in plastic surgery Number Four. London: Churchill Livingstone; 1992:29-39
Randall P, LaRossa D, Cohen SR, Cohen MA. The double opposing z-plasty for palate closure. Part 2 In: Jackson IT, Sommerland BC. eds. Recent advances in plastic surgery Number Four. London: Churchill Livingstone. 1992:41-44
Eric A Mann , James D. Sidman. Results of cleft palate repair with the double-reverse Z-plasty performed by residents. Arch Otolaryngol of Head and Neck Surg. 1994, 111(1): 76-80
E. Gunther, J. R. Wisser, M.A. Cohen, A.S. Brown. Palatoplasty: Furlow’s double reversing Z-plasty versus intravelar veloplasty. Cleft Palate Craniofac J. 1998, 35(6): 546-549
D. A. Hudson, A. O. Grobbelaar, D. B. Fernandes, R. Lentin. Treatment of velopharyngeal incompetence by the Furlow Z-plasty. Ann Plast Surg. 1995, 34(1): 23-26
William H. Lindsay, Paul T. Davis. Correction of velopharyngeal insufficiency with Furlow palatoplasty. Arch Otolarygol Head Neck Surg. 1996, 122:881-884
Rohrich RJ, Roswell AR, Johns DF, Drury MA, Greig G, Watson DJ, Godfrey AM, Poole MD. Timing of hard palate closure: a critical long-term analysis. Plast Reconstr Surg. 1996, 98:236-246
Emory RE, Clay RP, Bite U, Jackson IT. Fistula formation and repair after palatal closure: an institutional perspective. Plast Reconstr Surg. 1997, 99:1535-1538.
Muzaffar AR, Byrd HS, Rohrich RJ, Johns DF, LeBlance D, Beran SJ, Anderson C, Papaioannou A. Incidence of cleft palate fistula: an institutional experience with two stage palate repair. Plast Reconstr Surg. 2001, 108:1515-1518
LaRossa D, Jackson OH, Kirschner RE, Low DW, Solot CB, Cohen MA, Mayro R, Wang P, Minughpurvis N, Randall P. The children’s hospital of philadelphia modification of Furlow double opposing z-palatoplasty: long-term speech and growth results. Clin Plast Surg. 2004,31:243-249
M. Y. Mommaerts, F.A.A.M Combes, D Drake. The Furlow’s Z-plasty in two staged palatal repair modification and complication. Br J Oral and Maxillofac Surg. 220, 44: 94-9.
Phua YS, deChalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990-2004. Cleft Palate Craniofac J. 2008,45:172-178.
Gupta R, Kumar S, Murarka A K, Mowar A. Some modification of Furlow palatoplasty in wide cleft-a preliminary report. Cleft palate craniofac J. 2011,48:9-19
McCarthy JG. Introduction to plastic surgery. In: McCarthy JG, ed. Plastic surgery. Philadelphia: WB Saunders; 1990:55-56
Ethem Guneren, O. Ata Uysal. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg. 2004, 62: 446-450
Peter Randall, Donato LaRossa, Mark Solomon, Marilyn Cohen. Experience with the Furlow double-reversing Z-plasty for cleft palate repair. Plast Reconstr Surg. 1986, 77(4):569-576
Betty Jane Mc Williams, Peter Randall, Don LaRossa, Steven Cohen, Jack Yu, Marylyn Cohen, Cynthia Solot. Speech characteristic associated with Furlow palatoplasty as compared to other surgical techniques. Plast Reconstr Surg. 1996, 98(4):610-619
Richard E. Kirschner, Peter Wang, Abbas F. Jawad, Michael Duran, Marilyn Cohen, Cythia Solot, Peter Randall, Don LaRossa. Cleft-palate repair by modified Furlow double- opposing Z-plasty: The children’s hospital of Philedelphia experience. Plast Reconstr Surg. 1999, 104(7):1998-2010
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