Cleft-palate repair by modified Furlow double-opposing Z-plasty: The Children's Hospital of Philadelphia experience

Although the optimal technique of cleft-palate repair remains controversial , several small series have suggested that superior speech results may be o btained with the Furlow double-opposing Z-plasty. To examine speech outcome in a large series of Furlow palatoplasties performed at a single center, w e retrospectively reviewed the records of 390 cleft-palate patients who und erwent Furlow palatoplasty at The Children's Hospital of Philadelphia from 1979 to 1992. Speech outcome at 5 years of age or greater was available for 181 nonsyndromic patients and was scored using the Pittsburgh Weighted Val ues for Speech Symptoms Associated with Velopharyngeal Incompetence. No or mild hypernasality was noted in 93.4 percent of patients, with 88.4 percent demonstrating no or inaudible nasal escape and 97.2 percent demonstrating no errors in articulation associated with velopharyngeal incompetence. Seco ndary pharyngeal flap surgery was required in just 7.2 percent of patients. Age at palatoplasty, cleft type, and experience of the operating surgeon h ad no significant effect on speech results, although there was a trend towa rd better outcome in those undergoing palatal repair before 6 months of age and toward poorer outcome in those with Veau class I and II clefts. Overal l, Furlow palatoplasty yielded outstanding speech results, with rates of ve lopharyngeal dysfunction that seem to improve upon those reported for other techniques.