title: Clinical outcomes of the Furlow Z-plasty for primary cleft palate repair.
abstract: OBJECTIVE
  To review the clinical outcomes following the Furlow Z-plasty for primary cleft palate repair. The primary objective was to determine if the presence of an associated sequence or syndrome (i.e., Pierre Robin sequence), age at palate repair, cleft type, or surgeon experience influenced speech outcomes after a Furlow Z-plasty.
  
  
  METHODS
  The outcomes of 140 patients who underwent palate repair were analyzed retrospectively. Speech evaluations were performed to score the severity of hypernasality, nasal escape, articulation errors, and velopharyngeal insufficiency.
  
  
  RESULTS
  The mean age at latest evaluation was 4 years 9 months (age range 2 years old to 12 years old and 4 months). Of the 140 patients, 83% had no evidence of hypernasality, 91% had no presence of nasal escape, and 69% had no articulation errors. Overall, 84% of patients had no evidence of velopharyngeal insufficiency. Secondary posterior pharyngeal flap to correct velopharyngeal insufficiency was required in only 2.1% of patients. The formation of an oronasal fistula occurred in only 3.6% of patients. Nonsyndromic patients with Pierre Robin sequence and syndromic patients did just as well as purely nonsyndromic patients in terms of velopharyngeal insufficiency, hypernasality, and nasal escape. Syndromic patients were more likely to make mild-to-moderate articulation errors. In addition, age at palate repair, cleft type, and surgeon experience had no statistically significant effect on speech results.
  
  
  CONCLUSIONS
  The Furlow Z-plasty yielded excellent speech results in our patient population with minimal and acceptable rates of fistula formation, velopharyngeal insufficiency, and the need for additional corrective surgery.
authors.affiliation: University of Washington, Seattle, Washington, USA.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Khosla
authors.forename: Kelly
authors.initials: K
authors.lastname: Mabry
authors.forename: Charles L
authors.initials: CL
authors.lastname: Castiglione
mesh_terms: D000367:Age Factors; D001184:Articulation Disorders / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009668:Nose Diseases / Q000209:etiology; D016155:Oral Fistula / Q000209:etiology; D010614:Pharynx / Q000601:surgery; D010855:Pierre Robin Syndrome / Q000150:complications; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000209:etiology; D012189:Retrospective Studies; D013064:Speech Disorders / Q000209:etiology; D013524:Surgical Flaps; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000601:surgery; D014832:Voice Disorders / Q000209:etiology