28. Comparison of Furlow and Straight Line Repair Techniques on Transverse Dental Arch Dimensions and Extent of Orthodontic Intervention

PURPOSE: While the Furlow and straight line repair are the most commonly performed palatoplasty techniques, studies have advocated for the Furlow technique as it provides an increase in palatal lengthening. However, the Furlow technique’s impact on the transverse axis of the dental arch has yet to be explored. This study aims to compare the impact of the Furlow and straight line repair techniques on the transverse dental arch dimensions and the extent for postoperative orthodontic interventions. METHODS: A retrospective chart review of patients with cleft palate with or without a cleft lip at an urban pediatric medical center receiving care from senior surgeons between 1997-2022 was completed. Variables including cleft characteristics, repair type, and orthodontic evaluation and interventions were collected. Patients undergoing straight line repairs (SLR) were compared to those undergoing Furlow palatoplasty. Data were analyzed using Wilcoxon and Chi-Squared analyses in R Studio 4.2.1. RESULTS: Of 1,552 patients with cleft lip and palate deformities, 53% underwent Furlow repair and 47% underwent SLR. SLR was associated with increased rates of maxillary narrowing (orthodontist reported) when compared to Furlow repairs (47% vs 33%, p=.013). Additionally, patients undergoing SLR demonstrated higher rates of orthodontic transverse palatal expansion compared to the Furlow cohort (45.88% vs 30.19%, p=.002). Sub-analysis by cleft type demonstrated that this relationship was only maintained in Veau IV clefts and not in Veau I-III, where the repair technique did not influence rates of transverse palatal expansion. CONCLUSION: This data associates SLR with increased prevalence of maxillary narrowing and transverse palatal expansion, particularly in veau IV cleft phenotypes. A potential explanation is that the greater width of bilateral clefts may require more extensive dissection, contributing to increased scarring and transverse maxillary hypoplasia when completing straight line repair. When counseling patients and families on benefits of various repair techniques, Veau IV clefts should be advised that more extensive orthodontic interventions may be required with straight line repair techniques.