Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Results of Primary Repair of Submucous Cleft Palate with Furlow Palatoplasty in Both Syndromic and Non-syndromic Children
Zhi Yang Ng, MBChB, Selena Young, PhD, Yong Chen Por, FAMS (Plast Surg), Vincent Yeow, FAMS (Plast Surg).
Cleft and Craniofacial Centre, KK Women's and Children's Hospital, Singapore, Singapore.

PURPOSE:
Submucous cleft palate (SMCP) is an often-missed diagnosis until the child has developed abnormal speech. This often results as a consequence of aberrant anatomy, leading to velopharyngeal insufficiency and/or articulation errors. While the latter can usually be corrected with speech therapy, much controversy persists with regard to the optimal technique for surgical repair in the former. Moreover, when SMCP occurs as part of a syndrome, surgery has yielded mixed results. This study therefore aims to investigate outcomes of primary SMCP repair with Furlow palatoplasty in both syndromic and non-syndromic children.
METHODS:
Records of patients with SMCP who underwent primary repair with Furlow palatoplasty by the two senior authors (YCP, VY) at our institution between 2004 and 2012 were reviewed. Data for age at surgery, follow-up duration, presence of concomitant hearing loss, diagnosis of syndrome type, pre- and post-operative nasopharyngoscopy, perceptual and nasometry assessments, and secondary surgery rates were collected and analyzed using standard statistical methods; patients who were less than 4 years old at the time of surgery and with less than 6 months' follow-up were excluded.
RESULTS:
Of 46 patients identified, 34 (15 males, 44%) satisfied our inclusion criteria. Patient demographics include: mean age at surgery = 7.7 years (range 4.5-14), syndromic patients = 50% (velocardiofacial syndrome, n = 13), associated hearing loss = 11 patients (32%), and a mean follow-up period of 48 months (range 9-80). All patients underwent primary Furlow palatoplasty and there were no post-operative complications such as wound dehiscence or fistula; two patients (one syndromic, one non-syndromic) however required secondary procedures (revision Furlow palatoplasty ± pharyngeal flap). Post-operative nasopharyngoscopy revealed an increase in the number of patients with a coronal velopharyngeal closing pattern and greater velar closing ratios for all patients (p<0.05). Velar closing ratios on nasopharyngoscopy also approached normal at an average of 1.3 years (range 1-4) after surgery for all patients but nasometry values did not improve significantly for syndromic patients (Table 1).
CONCLUSION:
At our institution, Furlow palatoplasty is the technique of choice for primary SMCP repair, regardless of velar closing ratios or the presence of associated syndromes. Pre- and post-operative speech therapy has a vital role to play in both the initial assessment and rehabilitation of patients who have undergone surgery for SMCP. Further studies with greater patient numbers are necessary to achieve population statistical significance. As well, future research to elucidate the optimal timing of primary SMCP repair is warranted in both syndromic and non-syndromic patients.
Table 1. Nasometry and nasopharyngoscopy results after primary Furlow palatoplasty for SMCP
Pre-operativePost-operative
Nasometry:
All patients
Syndromic patients
Non-syndromic patients
56±12%
61±10%
51±11%
46±14%
52±11%
40±14%
p<0.05
p=0.03
p<0.05
Percentage of patients with velopharnygeal closure pattern:
Circular
Coronal
Circular + Passavant's ridge
73%
17%
10%
50%
32%
18%
Velar closing ratio:
All patients
Syndromic patients
Non-syndromic patients
0.73±0.22
0.72±0.18
0.74±0.26
0.94±0.08
0.93±0.09
0.95±0.08
p<0.05
p<0.05
p<0.05


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