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The goals of cleft palate surgery are to achieve closure of the palate, separating the oral and nasal cavities, thereby allowing for normal speech and swallowing function, whilst optimizing maxillofacial growth.1 The timing of surgery and technicalities of procedures employed to achieve anatomic closure of the cleft remains an active area of investigation. This discussion reflects the competing treatment priorities of achieving functional reconstruction whilst optimizing midfacial growth. Earlier surgery with more radical dissection may achieve better re-alignment of structures and speech outcomes, however this can be at the expense of harmonious facial growth as the vascular supply of the growing mid-face is impeded. Cleft surgeons have therefore striven to devise procedures that are able to restore the form and function of the palate whilst minimizing this disruption. The Furlow palatoplasty, first described in 1978,2 makes innovative use of z-plasties to lengthen and re-orientate the musculature of the soft palate. It has the benefits of elegant simplicity, it is easy to teach and does not require a microscope to perform and good speech outcomes have been reported, however it has been criticized for the non-anatomic repositioning of the velar musculature. The original procedure has been adopted, and modified by multiple centres worldwide. In this paper we review the use of modified Furlow procedures for primary palate repair.
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