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Brooker JE, Bykowski M, Cray JJ, et al. Outcomes of Furlow Double-Opposing Z-Plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study. Plast Reconstr Surg. 2021;147(5):1141-1148doi: 10.1097/PRS.0000000000007897.
Brooker, J. E., Bykowski, M., Cray, J. J., Beiriger, J., Roy, E., Ford, M. D., Grunwaldt, L., Davit, A., Goldstein, J. A., Jabbour, N., & Losee, J. E. (2021). Outcomes of Furlow Double-Opposing Z-Plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study. Plastic and reconstructive surgery, 147(5), 1141-1148. https://doi.org/10.1097/PRS.0000000000007897
Brooker, Jack E, et al. "Outcomes of Furlow Double-Opposing Z-Plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study." Plastic and reconstructive surgery vol. 147,5 (2021): 1141-1148. doi: https://doi.org/10.1097/PRS.0000000000007897
Brooker JE, Bykowski M, Cray JJ, Beiriger J, Roy E, Ford MD, Grunwaldt L, Davit A, Goldstein JA, Jabbour N, Losee JE. Outcomes of Furlow Double-Opposing Z-Plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study. Plast Reconstr Surg. 2021 May 01;147(5):1141-1148. doi: 10.1097/PRS.0000000000007897. PMID: 33890896.
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Plast Reconstr Surg. 2021 May 01;147(5):1141-1148. doi: 10.1097/PRS.0000000000007897.

Outcomes of Furlow Double-Opposing Z-Plasty Palatoplasty for the Treatment of Symptomatic Overt and Occult Submucous Cleft Palate: A Comparison Study.

Plastic and reconstructive surgery

Jack E Brooker, Michael Bykowski, James J Cray, Justin Beiriger, Eva Roy, Matthew D Ford, Lorelei Grunwaldt, Alexander Davit, Jesse A Goldstein, Noel Jabbour, Joseph E Losee

Affiliations

  1. From the Departments of Plastic Surgery and Otolaryngology and the School of Medicine, University of Pittsburgh; Ohio State University; and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.

PMID: 33890896 DOI: 10.1097/PRS.0000000000007897

Abstract

BACKGROUND: The submucous cleft palate can be overt or occult and may require surgical repair. The double-opposing Z-plasty (Furlow repair) is the authors' center's preferred approach. This study evaluated complication rates, differences in outcome between overt and occult types, and patient factors associated with surgical failure.

METHODS: This retrospective study reviewed documentation on all patients who underwent Furlow Z-plasty for submucous cleft palate at a single center between 2004 and 2018. Speech pathology was quantified using the Pittsburgh Weighted Speech Score.

RESULTS: A total of 351 patients were included (125 overt and 226 occult cases). Furlow Z-plasty was successful (postoperative Pittsburgh Weighted Speech Score <7 without recommendation for secondary speech surgery) in 291 patients (82.1 percent). Apart from those requiring secondary surgery, there were no documented complications. Occult-type patients were 7.5 years old at palatoplasty with a speech score of 14.1; overt-type patients were 6.5 years old with a score of 15.7. Postoperative speech scores were similar for both groups. Secondary speech surgery patients had a higher preoperative score (16.9 versus 14.2). Age at time of palatoplasty and submucous cleft palate type were not predictive of the need for secondary surgery. Syndromic patients had higher preoperative and postoperative speech scores (15.6 and 7.5, respectively) than nonsyndromic patients (14.3 and 4.3) and needed secondary surgery more often (24.4 percent versus 9.2 percent). V-shaped velar vaulting on preoperative assessment was present in 92 percent of occult-type patients.

CONCLUSIONS: Furlow palatoplasty is a safe and effective means of repairing submucous cleft palate. Patients with the occult type presented later with a lower Pittsburgh Weighted Speech Score. High preoperative speech score and syndromic status were associated with the need for secondary speech surgery. V-shaped velar vaulting is a reliable sign of occult submucous cleft palate.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Copyright © 2021 by the American Society of Plastic Surgeons.

Conflict of interest statement

Disclosure:The authors have no conflicts of interest. No funding was provided for the preparation of this article.

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