Figure 4: (Left) Patient with submucous cleft palate and VPI requiring Furlow Z-palatoplasty. (Right) The same patient after Furlow Z-palatoplasty.
interventional trial of speech therapy for 6 to 12 months. 26 In those patients for whom surgery is indicated, the Furlow Z-palatoplasty is used as our primary repair procedure. 13 The Z-palatoplasty offers the advantage of directly correct- ing the dysfunctional anatomy, creating a functional velar musculature while simultaneously lengthening the palate, and avoids undermining the mucosa of the hard palate. Our patients are followed closely after the procedure and only undergo secondary pharyngeal flap if it is clear that there is persistent or recurrent VPI. The patients in our series experienced a 67% success rate for correction of VPI with primary Z-palatoplasty, 33% of the patients ultimately required a secondary pharyngeal flap. Interestingly, when we stratified our patient popula- tion to account for association of genetic syndromes, we noticed a higher rate of failure in the syndromic (50%) when compared to non-syndromic patients (14%). The average age at surgery (4 years in syndromic patients vs. 7.3 years in non-syndromic patients) was almost doubled in the non- syndromic patient population. The need for PE tubes was also more frequent in the syndromic patients. This may indicate that the functional deficit was less severe in the non- syndromic population or that population may potentially have been able to better compensate for their VPI, and thus, further delayed diagnosis. CONCLUSION We found the Furlow Z-palatoplasty to be an effective procedure in the treatment of patients with submucous cleft palate and VPI. With this procedure, one can achieve adequate correction of VPI and avoid secondary corrections in the majority of patients, particularly in those patients without evident genetic syndromes. We were able to achieve functional oral-nasal balance in two-thirds of our patients. Through its success at our institution, we recommend the
use of the Furlow Z-palatoplasty in the correction of velo- pharyngeal incompetence. REFERENCES 1. Roux, JP. Memoires sur Staphylorrhaphie , p. 84. J.S. Chaude, Paris, 1825. 2. Calnan, JS. Submucous Cleft Palate. Brit. J. Plast. Surg ., 6: 264-282, 1954. 3. Seagle MB, Patti CS, Williams WN, Wood VD. Submucous Cleft Palate: A 10-year Series. Ann. Plast. Surg . 42: 142-148, 1999. 4. Kaplan, E. The Occult Submucous Cleft Palate. Cleft Palate J . 12: 356-265, 1975. 5. Weatherly-White RC, Sakura C, Brenner L, Stewart J, Ott J. Submucous Cleft Palate: Its Incidence, Natural History, and Inidications for Treatment. Plast and Reconstr Surg . 49: 297-304, 1972. 6. Lindeman G, Sewerin P. Prevalence of Cleft Uvulae among 2732 Danish Cleft Palates. Cleft Palate J . 14: 226-231, 1967. 7. Mesking L, Gorlin R, Issalsom RJ. Abnormal Morphology of the Soft Palate. Cleft Palate J . 1: 342-346, 1964. 8. Shapiro BL, Meskin LH, Cervenka J, Pruzansky S. Cleft Uvulae: a microformof facial clefts and its genetic basis. The Third Conference on the Clinical Delineation of Birth Defects. Baltimore, June, 1970. Baltimore: Williams & Wilkins, 80-82. 9. VelascoMG, Ysunza A, Hernandez X, Marquez C. Diagnosis and Treatment of Submucous Cleft Palate: AReviewof 108 Cases. Cleft Palate Journal . 25: 171-173, 1988. 10. Shprintzen R, Schwartz R, Daniller A, Hoch L. Morphologic Significance of Bifid Uvula. Pediatrics . 75: 553-561, 1985. 11. Ysunza A, Pamplona MC, Mendoza M, Molina F, Martinez P, Velasco M, Prada N. Surgical Treatment of Submucous Cleft Palate: AComparative Trial of TwoModalities for Palatal Closure. Plast and Reconstr Surg . 107: 9-14, 2001. 12. Peat B, Albery E, Jones K, Pigott R. Tailoring Velopharyngeal Surgery: The Influence of Etiology and Type of Operation. Plast and Reconstr Surg . 93: 948-953, 1994. 13. Chen, PK, Wu J, Hung KF, Chen YR, Noordhoff SM. Surgical Correction of the Submucous Cleft Palate with Furlow Palatoplasty. Plast and Reconstr Surg . 97: 1136-1146, 1996.
J La State Med Soc VOL 166 January/February 2014 19
Made with FlippingBook - Online catalogs