title: The Furlow palatoplasty for velopharyngeal dysfunction: velopharyngeal changes, speech improvements, and where they intersect.
abstract: OBJECTIVE
  We investigated how Furlow palatoplasty changes velopharyngeal morphology and speech characteristics, as well as how the anatomical and clinical results might be related. We hypothesized that Furlow palatoplasty would result in measurable velar elongation, tightening of the genu angle, and retropositioning of the levator sling and that the achievement of these modifications might be associated with clinical speech improvement.
  
  
  METHODS
  Retrospective analysis of preoperative and postoperative videofluoroscopic and speech data.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  A total of 29 patients with velopharyngeal insufficiency in the setting of previous cleft palate repair or submucous cleft palate.
  
  
  METHODS
  Furlow palatoplasty for treatment of velopharyngeal insufficiency.
  
  
  METHODS
  Lateral videofluoroscopy and perceptual speech examination were conducted preoperatively and postoperatively in order to measure velopharyngeal dimensions and speech quality. We describe anatomical and speech changes associated with the Furlow palatoplasty and undertake an exploratory analysis of the relationship between surgical changes to the velopharynx and clinical outcomes.
  
  
  RESULTS
  Furlow palatoplasty results in significant velar elongation, increased acuity of the genu angle, and retropositioning of the levator sling. Postoperative speech improvement was identified on the three subscales of resonance, nasal emission, and stops/plosives. Speech improvement and the absence of need for reoperation were most consistently associated with tightening of the genu angle.
  
  
  CONCLUSIONS
  Furlow palatoplasty lengthens the palate, while both tightening and retropositioning the levator sling. These changes reflect transverse recruitment of lateral velar tissues, along with transverse tightening and anterior release of the muscle fibers, respectively. Levator tightening is most consistently associated with improved speech outcomes.
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Pet
authors.forename: Lynn
authors.initials: L
authors.lastname: Marty-Grames
authors.forename: Mary
authors.initials: M
authors.lastname: Blount-Stahl
authors.forename: Babette S
authors.initials: BS
authors.lastname: Saltzman
authors.forename: David W
authors.initials: DW
authors.lastname: Molter
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D010160:Palate, Soft / Q000601:surgery*; D012189:Retrospective Studies; D013060:Speech; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D014741:Video Recording
keywords: Furlow palatoplasty; speech surgery; velopharyngeal insufficiency