Early Assessment after Cleft Palate Repair: Comparative Study between Furlow's and Rotational Flap Techniques.

Abstract

Background: A cleft palate is caused by the failure of fusion of the palatal shelves of the maxillary processes, resulting in a cleft of the hard and/or soft palates. This study aims to evaluate the various outcomes of cleft palate surgery, using Furlow's technique and rotational flap technique, with special emphasis on postoperative velopharyngeal competence through early assessment by nasoendoscopy.

Patients and methods: This randomized clinical trial was conducted on 64 cleft palate children at the pediatric surgical unit, in a tertiary pediatric hospital, from February 2022 to February 2024. Patients were randomized into Group A: Furlow Z-plasty technique and Group B: rotational flap palatoplasty. Operative details, outcomes, and complications were recorded and compared between both study groups.

Results: The ratio of males to females in both groups was 1:1, with a mean age of 10 months among study participants. Our results showed no difference between both groups regarding immediate postoperative complications, as well as the rate of fistula and dehiscence. Both techniques provide comparable outcomes in low-grade clefts regarding velopharyngeal competence. For higher-grade clefts, adding buccinator flaps with Furlow improves velopharyngeal valve (VPV) competence with notable differences in palatal mobility and lateral pharyngeal wall mobility scores, yet these are not statistically significant. However, it is at the expense of statistically longer operative time.

Conclusion: On short-term follow-up, both techniques, Furlow and rotation palatoplasty, offer comparable results regarding VPV function on low-grade clefts (Veau I). Moreover, in higher-grade clefts, the addition of buccal flaps has a considerable effect on VPV competence.