title: Outcomes of combined Furlow palatoplasty and sphincter pharyngoplasty for velopharyngeal insufficiency.
abstract: OBJECTIVE
  To compare surgical outcomes between pharyngeal flap, sphincter pharyngoplasty, and combined Furlow palatoplasty and sphincter pharyngoplasty in the management of pediatric velopharyngeal insufficiency.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care pediatric hospital.
  
  
  METHODS
  After exclusion of children with velocardiofacial syndrome, 96 patients who underwent surgical intervention between 2008 and 2012 were identified. Surgical interventions were categorized as pharyngeal flap, sphincter pharyngoplasty, and combined Furlow palatoplasty and sphincter pharyngoplasty. Main outcome measures included perceptual speech analyses, complications, and surgical revision rates.
  
  
  RESULTS
  Of the 96 reviewed patients, 38 (39.6%) underwent pharyngeal flap, 20 (20.8%) sphincter pharyngoplasty, and 38 (39.6%) combined Furlow palatoplasty and sphincter pharyngoplasty. Choice of surgical intervention was based on patient characteristics, observed palatal length, and formal speech assessments. There were no differences in patient demographics or preoperative perceptual speech analysis scores among the 3 surgical groups. The mean speech improvement was significantly greater in both the pharyngeal flap (P = .031) and combined procedure (P = .013) compared with sphincter pharyngoplasty alone, but no differences were observed between the pharyngeal flap and combined procedure (P = .797). There were no differences in complications among the 3 surgical interventions (P = .220). The combined procedure required significantly less surgical revisions than the pharyngeal flap (P = .019).
  
  
  CONCLUSIONS
  Combined Furlow palatoplasty and sphincter pharyngoplasty is an effective procedure for the management of pediatric velopharyngeal insufficiency and may result in superior speech outcomes and lower revision rates than sphincter pharyngoplasty and pharyngeal flap, respectively.
authors: Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.
authors: Lauren A
authors: LA
authors: Bohm
authors: Noëlle
authors: N
authors: Padgitt
authors: Robert J
authors: RJ
authors: Tibesar
authors: Timothy A
authors: TA
authors: Lander
authors: James D
authors: JD
authors: Sidman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D019647:Oral Surgical Procedures / Q000379:methods*; D010159:Palate / Q000601:surgery*; D010614:Pharynx / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D055815:Young Adult
keywords: Furlow palatoplasty; outcomes; pediatric; sphincter pharyngoplasty; velopharyngeal insufficiency