title: Improving speech outcomes after failed palate repair: evaluating the safety and efficacy of conversion Furlow palatoplasty.
abstract: BACKGROUND
  Velopharyngeal insufficiency occurs in a nontrivial number of cases following cleft palate repair. We hypothesize that a conversion Furlow palatoplasty allows for long-term correction of VPI resulting from a failed primary palate repair, obviating the need for pharyngoplasty and its attendant comorbidities.
  
  
  METHODS
  A retrospective review of patients undergoing a conversion Furlow palatoplasty between 2003 and 2010 was performed. Patients were grouped according to the type of preceding palatal repair. Velopharyngeal insufficiency was assessed using Pittsburgh Weighted Speech Scale (PWSS). Scores were recorded and compared preoperatively and postoperatively at 3 sequential visits.
  
  
  RESULTS
  Sixty-two patients met inclusion criteria and were grouped by preceding repair (straight-line repair (n = 37), straight-line repair with subsequent oronasal fistula (n = 14), or pharyngeal flap (n = 11). Median PWSS scores at individual visits were as follows: preoperative = 11, first postoperative = 3 (mean, 114.0 ± 6.7 days), second postoperative = 1 (mean, 529.0 ± 29.1 days), and most recent postoperative = 3 (mean, 1368.6 ± 76.9 days). There was a significant difference between preoperative and postoperative PWSS scores in the entire cohort (P < 0.001) with overall improvement, and post hoc analysis showed improvement between each postoperative visit (P < 0.05) with the exception of the second to the most recent visit. There were no differences between postoperative PWSS scores in the operative subgroupings (P > 0.05). Eight patients failed to improve and showed no differences in PWSS scores over time (P > 0.05). Patients with a PWSS score of 7 or greater (n = 8) at the first postoperative visit (0-6 months) displayed improvement at the most recent visit (P< 0.05).
  
  
  CONCLUSIONS
  Conversion Furlow palatoplasty is an effective means for salvaging speech. Future studies should elucidate which factors predict the success of this technique following failed palate repair.
authors.affiliation: From the *Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and †Departments of Oral Biology and Surgery/Plastic Surgery, Georgia Health Sciences University, Augusta, Georgia.
authors.forename: Harry S
authors.initials: HS
authors.lastname: Nayar
authors.forename: James J
authors.initials: JJ
authors.lastname: Cray
authors.forename: Zoe M
authors.initials: ZM
authors.lastname: MacIsaac
authors.forename: Anne E
authors.initials: AE
authors.lastname: Argenta
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Ford
authors.forename: Regina A
authors.initials: RA
authors.lastname: Fenton
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.forename: Lorelei J
authors.initials: LJ
authors.lastname: Grunwaldt
mesh_terms: D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009668:Nose Diseases / Q000601:surgery; D016155:Oral Fistula / Q000601:surgery; D010159:Palate / Q000601:surgery*; D010614:Pharynx / Q000601:surgery; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000601:surgery; D012189:Retrospective Studies; D012449:Safety; D013060:Speech / Q000502:physiology*; D013064:Speech Disorders / Q000601:surgery; D013065:Speech Intelligibility / Q000502:physiology; D013524:Surgical Flaps / Q000601:surgery; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D014945:Wound Healing