Conversion Furlow palatoplasty: salvage of speech after straight-line palatoplasty and "incomplete intravelar veloplasty".
BACKGROUND
The straight-line palatoplasty with intravelar veloplasty (IVVP) is one option for cleft palate repair. However, not all IVVPs are performed uniformly. Many IVVPs only address the medialmost portion of the levator muscle, an "incomplete IVVP," failing to completely dissect and adequately transpose the entire levator muscle, "complete IVVP." We believe that for optimal speech results, IVVPs should completely mobilize and posteriorly displace the levator. We propose that a conversion Furlow palatoplasty performed with a "complete IVVP" will correct postoperative velopharyngeal insufficiency (VPI) and alleviate the need for pharyngoplasty.


METHODS
Nineteen patients with postoperative VPI, having had prior straight-line palatoplasty and reported "IVVP," underwent conversion Furlow palatoplasty. Those with a pre- and postoperative Pittsburgh Weighted Speech Scale (PWSS) value and no other history of palatal surgeries were included in this study. Statistical analysis was performed by using the Wilcoxon signed ranks test.


RESULTS
Patients' median age was 5.5 years (range, 4-15 years), with 13 males and 7 females. The median preoperative PWSS score was 11.00 (range, 3-24.5), and the median postoperative was 1.00 (range, 0-5) (P < 0.001). All subcategories of the PWSS were also improved. Eight children had a preoperative fistula, and all were successfully corrected. At the time of conversion Furlow palatoplasty, all patients demonstrated no evidence of previous IVVP as the levator muscle was found to be scarred to the posterior edge of the hard palate.


CONCLUSIONS
The conversion Furlow palatoplasty can be used to significantly improve VPI and salvage speech after a straight-line palatoplasty with an "incomplete IVVP." Patients with postoperative VPI should first be considered for conversion Furlow palatoplasty performed with a "complete IVVP" prior to progressing to pharyngoplasty.
Noorchashm
Negin
N
Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Dudas
Jason R
JR
Ford
Matthew
M
Gastman
Brian
B
Deleyiannis
Fredrick W-B
FW
Vecchione
Lisa
L
Jiang
Shao
S
Cooper
Gregory M
GM
Haralam
Mary Ann
MA
Losee
Joseph E
JE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D010160:Palate, Soft / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013064:Speech Disorders / Q000601:surgery*; D014681:Velopharyngeal Insufficiency / Q000601:surgery*