Palatoplasty: Furlow's Double Reversing Z-Plasty Versus Intravelar Veloplasty

OBJECTIVE: To evaluate the efficacy of Furlow's double reversing z-plasty (Furlow) versus intravelar veloplasty with longitudinal closure including palatal muscle reorientation (IVV). DESIGN: Retrospective, single-institution, single-surgeon comparison. PATIENTS: One hundred nineteen consecutive cleft palate patients were enrolled; 34 syndromic and 9 language-impaired patients were removed from speech and reoperation analysis. Furlow and IVV groups were similar with respect to sex and mean age at primary repair. INTERVENTIONS: One surgeon performed all surgery and one of two speech pathologists conducted language and speech evaluations at 3 years of age without prior knowledge of the surgical technique utilized. OUTCOME MEASURES: Outcome measures included frequency of palatal fistulae, speech abnormalities, and need for secondary pharyngoplasty procedures. RESULTS: Patients who had undergone IVV demonstrated a 34% higher incidence of hoarseness, nasal escape, and hypernasality at 3 years of age than did Furlow patients. These same patients likewise required significantly more secondary pharyngoplasty procedures. No significant difference was noted between fistulae frequencies. CONCLUSIONS: These findings suggest that Furlow palatoplasty may provide a better clinical outcome than intravelar veloplasty.