Furlow palatoplasty for management of velopharyngeal insufficiency: a prospective study of 148 consecutive patients.
BACKGROUND
The objectives of the study were to describe speech outcomes in a large series of patients undergoing Furlow palatoplasty for management of velopharyngeal insufficiency and to test whether preoperative velopharyngeal gap size and other patient characteristics significantly affect those outcomes.


METHODS
Data collected included age at the time of surgery, surgeon, type of cleft, syndrome diagnosis, preoperative velopharyngeal gap size as determined by videonasendoscopy, and preoperative and postoperative perceptual speech assessments. Descriptive statistics were generated and ordinal logistic regression on the outcome variable, postoperative velopharyngeal insufficiency severity score, was performed.


RESULTS
In this series of 154 patients, 148 had complete perceptual speech data. Of these 148 patients, 72 percent had improvement in velopharyngeal insufficiency severity after the procedure and 56 percent had complete resolution of velopharyngeal insufficiency. Postoperative insufficiency was scored as none or minimal (i.e., resolution) in 38 of 52 patients (73 percent) with a small preoperative velopharyngeal gap, 26 of 51 patients (51 percent) with a moderate preoperative gap, and four of 21 patients (19 percent) with a large preoperative gap. Preoperative velopharyngeal gap size was significantly associated (p < 0.0001) with postoperative insufficiency on ordinal multivariate logistic regression after controlling for preoperative insufficiency and other covariates. There was not a significant association between syndrome diagnosis, age at Furlow palatoplasty (younger than 5 years versus older), gender, surgeon, or presence of submucous cleft palate and postoperative speech outcome, in either the unadjusted or adjusted analyses.


CONCLUSIONS
Preoperative velopharyngeal gap size, as determined with nasendoscopy, was significantly associated with postoperative velopharyngeal insufficiency severity after Furlow palatoplasty. Small gap size is associated with a greater likelihood of resolution.
Perkins
Jonathan A
JA
Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Lewis
Charlotte W
CW
Gruss
Joseph S
JS
Eblen
Linda E
LE
Sie
Kathleen C Y
KC
D000293:Adolescent; D000328:Adult; D001184:Articulation Disorders / Q000209:etiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010160:Palate, Soft / Q000601:surgery*; D011446:Prospective Studies; D012044:Regression Analysis; D013060:Speech; D013064:Speech Disorders / Q000209:etiology; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000150:complications / Q000601:surgery*