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      Outcomes of Primary Furlow Double-Opposing Z-plasty for the Treatment of Symptomatic Submucous Cleft Palate

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          Abstract

          Background:

          Submucous cleft palate (SMCP) requires surgical repair if symptomatic. The Furlow double-opposing Z-plasty is the preferred method in Helsinki cleft center.

          Aims:

          To assess the efficacy and complications of Furlow Z-plasty in the treatment of symptomatic SMCP.

          Methods:

          This retrospective study reviewed documentation of 40 consecutive patients with symptomatic SMCP who underwent primary Furlow Z-plasty by 2 high-volume cleft surgeons at a single center between 2008 and 2017. Patients underwent perceptual and instrumental evaluation of velopharyngeal function (VPF) by speech pathologists preoperatively and postoperatively.

          Results:

          The median age at Furlow Z-plasty was 4.8 years (SD 2.6, range 3.1–13.6). The overall success rate, including postoperative competent or borderline competent VPF, was 83%, and 10% required secondary surgery for residual velopharyngeal insufficiency. The success rate was 85% in nonsyndromic, and 67% in syndromic patients with no significant difference ( P=0.279). Complications arose in only 2 (5%) patients. No children were found to have obstructive sleep apnea postoperatively.

          Conclusion:

          Furlow primary Z-plasty is a safe and effective operation for symptomatic SMCP with a success rate of 83% with only 5% rate of complications.

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          Most cited references37

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          Cleft palate repair by double opposing Z-plasty.

          Mandi L Furlow (1986)
          In an attempt to improve speech results following palate repair while allowing adequate maxillary growth, a palatoplasty using two opposing Z-plasties of the soft palate, one of the oral and one of the nasal layers, has been used in 22 infants. Eight patients had unilateral cleft lip and palate, eight had bilateral cleft lip and palate, and six had cleft palate. The Z-plasties facilitate effective dissection and redirection of the palatal muscles to produce an overlapping muscle sling and lengthen the velum without using tissue from the hard palate, which permits hard palate closure without pushback or lateral relaxing incisions. Of the 20 children old enough for speech evaluation, 18 have no velopharyngeal insufficiency. Two have very mild velopharyngeal insufficiency. None has required a pharyngeal flap.
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            The cleft audit protocol for speech-augmented: A validated and reliable measure for auditing cleft speech.

            Alexandra Mary John, Debbie Sell, Triona Sweeney … (2006)
            To develop an assessment tool for use in intercenter audit studies of cleft speech and to test its acceptability, validity, and reliability. The tool is to be used systematically to record and report speech outcomes, providing an indication of treatment needs and continuing burden of care. Regional Cleft Center, U.K. The Cleft Audit Protocol for Speech-Augmented (CAPS-A) was developed by three cleft speech experts who identified the key features required from existing assessment measures. Criterion validity was assessed by comparing the Cleft Audit Protocol for Speech-Augmented outcomes reported for 20 cases with clinical assessment results and other investigations. Intra- and interrater reliability were tested following the training of specialist speech and language therapists who used the Cleft Audit Protocol for Speech-Augmented on two occasions to assess 10 cases. The raters evaluated acceptability and ease of using a questionnaire. The mean percentage agreement for criterion validity in each section was 87% (range 70% to 100%). Both intra- and interexaminer reliability were rated as good/very good (Kappa 0.61 to 1.00) for seven sections and moderate (Kappa 0.41 to 0.60) for three sections. Raters reported that the Cleft Audit Protocol for Speech-Augmented was acceptable and easy to use with appropriate training. An acceptable, valid, and reliable cleft speech audit tool has been developed based on a small sample. The Cleft Audit Protocol for Speech-Augmented is recommended for use in intercenter audit studies in the U.K. and Ireland and could be used in other English-speaking countries. In addition, it has wider applicability for use in reporting speech outcomes of surgical procedures.
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              Methodology for speech assessment in the Scandcleft project--an international randomized clinical trial on palatal surgery: experiences from a pilot study.

              B Hutters, Rachel M Bowden, G Henningsson … (2009)
              To present the methodology for speech assessment in the Scandcleft project and discuss issues from a pilot study. Description of methodology and blinded test for speech assessment. Speech samples and instructions for data collection and analysis for comparisons of speech outcomes across five included languages were developed and tested. PARTICIPANTS AND MATERIALS: Randomly selected video recordings of 10 5-year-old children from each language (n = 50) were included in the project. Speech material consisted of test consonants in single words, connected speech, and syllable chains with nasal consonants. Five experienced speech and language pathologists participated as observers. Narrow phonetic transcription of test consonants translated into cleft speech characteristics, ordinal scale rating of resonance, and perceived velopharyngeal closure (VPC). A velopharyngeal composite score (VPC-sum) was extrapolated from raw data. Intra-agreement comparisons were performed. Range for intra-agreement for consonant analysis was 53% to 89%, for hypernasality on high vowels in single words the range was 20% to 80%, and the agreement between the VPC-sum and the overall rating of VPC was 78%. Pooling data of speakers of different languages in the same trial and comparing speech outcome across trials seems possible if the assessment of speech concerns consonants and is confined to speech units that are phonetically similar across languages. Agreed conventions and rules are important. A composite variable for perceptual assessment of velopharyngeal function during speech seems usable; whereas, the method for hypernasality evaluation requires further testing.
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                Author and article information

                Contributors
                Veera Pitkänen:
                ORCID: http://orcid.org/0000-0001-9977-4695
                Anika Szwedyc
                Suvi Alaluusua
                Ahmed Geneid
                Pia Vuola
                Anne Saarikko
                Journal
                Journal ID (nlm-ta): J Craniofac Surg
                Journal ID (iso-abbrev): J Craniofac Surg
                Journal ID (publisher-id): SCS
                Title: The Journal of Craniofacial Surgery
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 1049-2275
                ISSN (Electronic): 1536-3732
                Publication date (Print): October 2023
                Publication date (Electronic): 24 May 2023
                Volume: 34
                Issue: 7
                Pages: 2066-2070
                Affiliations
                [* ]Department of Plastic Surgery, Cleft and Craniofacial Center
                [† ]Department of Otolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland
                Author notes
                Address correspondence and reprint requests to Veera Pitkänen, MD, PhD, Department of Plastic Surgery, Stenbäckinkatu 11, 00290 Helsinki, Finland; E-mail: veera.v.pitkanen@ 123456hus.fi
                Author information
                http://orcid.org/0000-0001-9977-4695
                Article
                Publisher ID: SCS-22-0912 Accession ID: 00037
                DOI: 10.1097/SCS.0000000000009385
                PMC ID: 10521778
                PubMed ID: 37221637
                SO-VID: 3bdc4f12-3cea-486d-87e6-26be61e25f3a
                Copyright © Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 3 November 2022
                Date accepted : 25 February 2023
                Categories
                Subject: Clinical Studies
                Custom metadata
                SDC T
                OPEN-ACCESS TRUE

                Keywords: double-opposing z-plasty,furlow,palatoplasty,submucous cleft palate,velopharyngeal insufficiency,vpi
                Data availability:
                Keywords: double-opposing z-plasty, furlow, palatoplasty, submucous cleft palate, velopharyngeal insufficiency, vpi

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