Submucous Cleft Palate Repair: Furlow Double-Opposing Z-Palatoplasty

32-month-old male with Coffin Siris syndrome, bilateral middle ear effusions, and velopharyngeal insufficiency who presents with a submucous cleft palate.

Furlow Double-Opposing Z-Palatoplasty
Submucous cleft palate, velopharyngeal insufficiency
Any medical conditions that preclude using general anesthesia. Patients with airway conditions or syndromes, such as Pierre Robin sequence, retrognathia, may need to be addressed before palatoplasty.
General otolaryngology set up including Dingman mouth gag, 6700 beaver blade, Dandy trigeminal scissor, Stevens tenotomy scissors, 0.25% Marcaine with epinephrine.
Feeding/speech therapy, medical clearance, consideration for concurrent myringotomy tubes, preoperative parental counseling
Variable severity of a bifid uvula, zona pellucida, and bony indentation in the posterior edge of the hard palate can be seen in patient with a submucous cleft palate. A submucous cleft palate may involve only the secondary palate or both the primary and secondary palate. The palate is divided into primary and secondary palates by the incisive foramen, where the primary palate is anterior to the foramen and the secondary palate is posterior to it.
Advantages: Furlow palatoplasty is offered as a surgical option for VPI in patient’s with a submucous cleft palate. Furlow palatoplasty provides lengthening of the palate with reorientation of the soft palate musculature in children with a submucous cleft palate. The overlap of the levator results in a better palatal sling. Studies have shown the rate of fistula formation and the rate of VPI were much less than in other procedures to repair a submucous cleft palate. Speech is excellent in reported studies and there is a lower recurrence of middle ear effusions. Disadvantages: The procedure can be technically challenging and requires a good knowledge of soft palate musculature.
Palatal fistula formation (rare), scarring, bleeding, infection
1. Ravishanker R. Furlow's Palatoplasty for Cleft Palate Repair. Med J Armed Forces India. 2006;62(3):239-242. doi:10.1016/S0377-1237(06)80010-9. 2. Puente Espel J, Hohman MH, Winters R. Cleft Palate Repair. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570586/ 3. Sie KC, Tampakopoulou DA, Sorom J, Gruss JS, Eblen LE. Results with Furlow palatoplasty in management of velopharyngeal insufficiency. Plast Reconstr Surg. 2001;108(1):17-29. doi:10.1097/00006534-200107000-00004. 4. Chen KT, Wu J, Noordhoff SM. Submucous cleft palate. Changgeng Yi Xue Za Zhi. 1994;17(2):131-137. https://pubmed.ncbi.nlm.nih.gov/8069735/

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