Incidence of Secondary Surgery after Modified Furlow Palatoplasty: A 20-Year Single-Surgeon Case Series

Objective: To determine the occurrence of velopharyngeal insufficiency (VPI) requiring surgery and fistula repair after primary palatoplasty using a “modified” Furlow technique. Study Design: Case series with chart review. Setting: Academic multidisciplinary cleft and craniofacial center. Subjects and Methods: Children younger than 18 years at presentation, with unrepaired cleft palate, with or without cleft lip, including submucous clefts, who underwent palatoplasty were included. No cleft patients having primary repair were excluded. All operations were conducted by a single surgeon from March 1994 through December 2013. Charts were reviewed for demographics, cleft type, genetic syndrome, operations performed, and complications, including VPI and oronasal fistula. Results: In total, 312 consecutive patients underwent primary palatoplasty (160 [51.3%] male) with a median age of repair of 0.95 (range, 0.47-17.6) years and followed for 6.49 (range, 4.0-20.2) years. Robin sequence was diagnosed in 109 (34.9%), 104 (33.4%) had alveolar clefts, and 27 (8.7%) had concomitant gingivoperiosteoplasty. A modified Furlow was performed in 289 (92.6%). Overall, 16 (5.1%) required subsequent pharyngeal flap for VPI, and 48 (15.4%) required oronasal fistula repair. Veau class II had higher pharyngeal flap rates (P =.033). Fistula repair was lower in Veau I (P <.001) but higher in Veau II (P <.001) and IV (P =.002). Older age (P =.034) and Robin sequence (P =.017) were associated with higher rates of oronasal fistula repair. Conclusions: The modified Furlow palatoplasty yields acceptable rates of secondary surgery for VPI without selection based on cleft width. While our oronasal fistula repair rate is high, it is concordant with previous reports and is likely related to our rare use of lateral relaxing incisions.