SURGICAL-CORRECTION OF SUBMUCOUS CLEFT-PALATE WITH FURLOW PALATOPLASTY

Many surgeons have favored using the pharyngeal flap as the primary tr eatment for the velopharyngeal insufficiency associated with submucous cleft palate. However, the increasing number of reports of sleep apne a and airway compromise as a result of pharyngeal flap surgery support the need to eliminate any unnecessary pharyngeal flap surgery. From 1 988 to 1993, 35 Chinese submucous cleft palate patients with velophary ngeal insufficiency received surgery. A Furlow palatoplasty was used i n 30 patients (3 to 26 years old). The follow-up duration was 9 months to 51/2 years. These patients were selected after a thorough study fo r velopharyngeal insufficiency including intraoral examination, percep tual speech assessment, videonasopharyngoscopy and/or multiview videof luoroscopy. The criteria for selection included age, intraoral finding of an obviously anteriorly inserted levator palatine muscle, size of velopharyngeal gap, pattern of velopharyngeal closure, degree of later al pharyngeal wall movement, and response to biofeedback speech therap y. In general, younger patients with circular or sagittal pattern clos ure, a velopharyngeal gap less than 5 mm, or good response to biofeedb ack speech therapy were considered to be the best candidates for a Fur low palatoplasty. The 5 patients who did not fulfill these criteria an d whose velopharyngeal function failed to improve on preoperative biof eedback therapy were treated by pharyngeal nap operation. Twenty-nine patients (96.7 percent) achieved competent velopharyngeal function aft er the Furlow palatoplasty. The procedure corrected the velopharyngeal insufficiency in 3 patients older than 20 years with a velopharyngeal gap of less than 2 mm. The only patient with an unsatisfactory result was a 26-year-old woman who had very prominent action of the musculus uvulae before the surgery. The results show that a Furlow palatoplast y can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients and thus avoid the serious c omplications of pharyngeal flap surgery.