Treatment of Submucous Cleft Palate With Selective Use of the Furlow Z-Palatoplasty
Michael H. Moses, MD; Mark W. Stalder, MD; David T. Pointer Jr., BS; Ryan Wong, MD; Charles L. Dupin, MD; Hugo St. Hilaire, MD, DDS
Purpose : Submucous cleft is an uncommon entity that can be complicated by functional abnormalities, spe- cifically velopharyngeal incompetence (VPI), secondary to abnormal palatal muscular insertion. This study aims to characterize our experience using the Furlow Z-palatoplasty for the treatment of VPI in patients with submucous clefts. Methods : A retrospective chart review was conducted looking at 24 patients diagnosed with symptomatic submucous clefts between 2000 and 2007 at Children’s Hospital of New Orleans. Demographics such as age, gender, diagnosis, need for surgical correction, type of operation, complications, presence of genetic syndromes, need for secondary surgery, and need for myringotomy tubes were examined. Results : The average age at initial surgery for the entire study population was 6.2 years. The success rate of our Furlow procedure was 66.7%, with 33.3% requiring secondary pharyngeal flaps. The genetic syndromic patient population had an average age at initial surgery of four years and experienced a lower primary suc- cess rate of 50%. The non-syndromic patient population had an average age at initial surgery of 7.3 years, with an 85.7% primary success rate. Conclusions : Our data supports the notion that Furlow Z-palatoplasty is an effective procedure in the treat- ment of submucous cleft palate with VPI, frequently without the need for secondary surgical procedures in the majority of patients, particularly those patients without syndromes.
INTRODUCTION First described by Roux more than 100 years ago, submucous cleft is an uncommon condition that is defined by the presence of three anatomical features: bifid uvula, palatal muscular diastasis, and notching of the hard pal- ate. 1-3 Kaplan further described the “occult submucous cleft” when he found that the same functional problem can occur in the presence of abnormal muscular insertion without the presence of the classic triad. 4 These similar conditions both can result in velopharyngeal incompetence (VPI) due to the abnormal insertion of the palatal musculature onto the hard palate instead of forming a continuous muscular sling across the midline. True submucous cleft occurs uncommonly, with inci- dence reports ranging from 1:1,200 to 1:20,000. 3-9 Also, the incidence of submucous cleft in patients demonstrating VPI has been reported to be between 27% and 62%. 4,10 Due to the relative scarcity of these patients, there is a paucity of literature addressing this condition, and its diagnosis and treatment remain a challenge for the physicians that care
for these patients. In the setting of submucous cleft with associated VPI, numerous procedures have been employed for surgical correction, including pharyngeal flaps, V-Y pushback palatoplasty, minimal incision palatopharyngoplasty, and Furlow Z-palatoplasty. 3,9,11-13 A consensus approach to treatment remains elusive, however. At our institution, for patients who are unresponsive to speech therapy, the Fur- low Z-palatoplasty is used for initial surgical management. Pharyngeal flaps are reserved as secondary procedures for patients in whom the initial Z-palatoplasty is unsuccessful. The purpose of this study is to report our experience using the Furlow Z-palatoplasty for primary correction of VPI in the submucous cleft population. The efficacy of this procedure was characterized based on subjective improve- ments in speech and the need for secondary procedures. METHODS A retrospective chart review was conducted for those patients diagnosed with submucous cleft that were seen
J La State Med Soc VOL 166 January/February 2014 15
Made with FlippingBook - Online catalogs