8. longitudinal outcomes in midfacial growth and speech following furlow double-opposing z-palatoplasty: a 30-year retrospective

PURPOSE: The purpose of this study was to evaluate the long-term outcomes of midfacial growth and speech following modified Furlow palatoplasty over a 15-year period. METHODS: A retrospective review was performed of subjects undergoing modified Furlow palatoplasty between 1990 and 2005. RESULTS: In total, 74 subjects met inclusion. The median age at palatoplasty was 11.0 months and age at follow-up was 18.0 years. Most subjects presented with Veau III (46.0) and IV (40.5%) clefts. Syndromic subjects accounted for 20.3% of subjects. Rates of ONF and VPD were 5.4% and 12.2%. Competent speech was noted in 93% following palatoplasty, 87.5% following orthodontic expansion, and 62.5% following orthognathic surgery. Secondary speech surgery following palatoplasty occurred in 12.2% of subjects. Steiner analysis at maturity noted a median SNA 77.4°, SNB 78.6°, ANB -2.3°, PNS – ANS 78.2 mm, and overjet -4.0 mm. At skeletal maturity, 52.7% of subjects (Veau III 44.1%, Veau IV 70%) demonstrated maxillary hypoplasia and 66.2% ultimately underwent orthognathic surgery (III 64.7%, IV 80.0%). Veau classification correlated with midface hypoplasia (p<0.05). Veau IV clefts demonstrated the highest rate of orthognathic surgery (80.0%, p<0.02). Orthognathic interventions included single stage movements (81.5%) and distraction osteogenesis (DO, 18.5%). CONCLUSION: Patients with cleft palate undergoing primary Furlow palatoplasty demonstrate characteristic effects on midface growth and speech. There is a trimodal age distribution of VPD likely related to underlying clinical events along the continuum of cleft care. Veau cleft classification may predict incidence of midface hypoplasia and subsequent need for orthognathic surgery at skeletal maturity.