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Speech Outcomes with Modified Furlow Palatoplasty: A 20-Year, Single-surgeon Experience
Nicolás M. Kass, Tobi Somorin
*, Angel Dixon, Megan Pencek, Matthew Ford, Michael Bykowski, Jesse A. Goldstein, Joseph Losee
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
BackgroundThe most critical outcome following cleft palate repair is velopharyngeal function, which can change over time. Rates of velopharyngeal insufficiency vary significantly across the literature, with surgical technique being a key factor. Recent advances in palatoplasty indicate that vascularized tissue augmentation during primary repair may improve outcomes. We report a single surgeon's outcomes across a 20-year period and evaluate the efficacy of incorporating vascularized tissue augmentation during primary modified Furlow palatoplasty.
MethodsThis retrospective cohort study examined 285 patients who underwent primary palatoplasty by a single surgeon over 20 years (2004-2024). The study period was divided into two phases based on whether a patient received a Furlow palatoplasty with or without vascularized tissue augmentation - tissue augmentation palatoplasty (TAP). Outcomes included rates of velopharyngeal insufficiency (VPI) requiring surgery, speech performance scores, and presence of clinically significant functional fistulas.
ResultsOver the entire study period, 37 patients (13.0%) underwent secondary speech surgery at median age of 6.2 years, with higher rates in complete clefts (p=.03). Fistula rate was 4.2% (n=12), exclusively in Veau III/IV defects (p=.027). Twelve patients (5.5%) in phase 1 experienced fistulas and zero patients (0.0%) experienced fistulas in phase 2 (p=.11). Secondary speech surgery was performed in 37 patients in phase 1 (16.8%) and 0 patients in phase 2 (0.0%) (p=.004).
ConclusionTissue augmentation palatoplasty significantly reduced the need for secondary speech surgery and eliminated fistula formation in this longitudinal single-surgeon experience. These findings support incorporating vascularized tissue during primary palatoplasty to optimize functional outcomes.
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