CORRECTION OF SECONDARY VELOPHARYNGEAL INSUFFICIENCY IN CLEFT-PALATE PATIENTS WITH THE FURLOW PALATOPLASTY

To avoid the serious complications of pharyngeal flap surgery, a Furlo w palatoplasty was used to correct velopharyngeal insufficiency after primary palatoplasty in 18 Chinese cleft palate patients (3 to 23 year s old) from 1988 to 1992. The follow-up duration was 1 to 4 years. The se patients were selected after a complete study for velopharygeal ins ufficiency, including intraoral examination, perceptual speech assessm ent, videonasopharyngoscopy, and/or multiview videofluoroscopy. The cr iteria for selection included age, pattern of velopharyngeal closure, size of the velopharyngeal gap, extent of lateral pharyngeal wall move ment, existence of a Passavant's ridge, and abnormal levator veli pala tini muscle insertion. Complete velopharyngeal closure was achieved fo r 16 patients after surgery The majority of these patients (15) had a velopharyngeal gap less than 5 mm. The 2 patients who still had veloph aryngeal insufficiency after the surgery had a velopharyngeal gap larg er than 10 mm before the surgery. The most important factor seemed to be the size of the velopharyngeal gap. Pattern of velopharyngeal closu re or age of the patient also might play an important role. The result s showed that a Furlow palatoplasty can satisfactorily correct velopha ryngeal insufficiency in care fully selected patients. Although the cr iteria for the selection of this operation need further study, present results are encouraging.