The modified Furlow palatoplasty - a review.

Main Article Content

H L Stark C A Fries N S G Mercer

Abstract

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.

Keywords: palatoplasty, , modified Furlow, cleft palate

Article Details

How to Cite
STARK, H L; FRIES, C A; MERCER, N S G. The modified Furlow palatoplasty - a review.. Medical Research Archives, [S.l.], v. 5, n. 11, nov. 2017. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1633>. Date accessed: 29 mar. 2024. doi: https://doi.org/10.18103/mra.v5i11.1633.
Section
Review Articles

References

1. Chorney SR, Commesso E, Tatum S. Incidence of secondary surgery after modified Furlow palatoplasty: A 20-year single-surgeon case series. Otolaryngology Head and Neck Surgery 2017 (Epub.)

2. Furlow LT. Cleft repair by double opposing z-plasty. Plastic and Reconstructive Surgery 1986; 78: 724-735.

3. Smith DM, Losee JE. Cleft Palate Repair. Clinics in Plastic Surgery 2014; 41: 189-210.

4. Jackson O, Stransky CA, Jawad AF, Basta M, Solot C, Cohen M, Kirschner R, Low DW, Randall P, LaRossa D. The Children’s Hospital of Philadelphia modification of the Furlow double opposing z-plasty: 30 year experience and long term speech outcomes. Plastic and Reconstructive Surgery 2013; 132: 613-622.

5. Dreyer TM, Trier WC. A comparison of palatoplasty techniques. Cleft Palate Journal 1984; 21: 251-253.

6. Ysunza A, Pamplona, MC, Quiroz, J, Yudovich J, Molina F, Gonzalez S. Maxillary growth in patients with complete cleft lip and palate, operated on around 4–6 months of age, Int. J. Pediatr. Otorhinolaryngol. 2010; 74: 482–485.

7. Katzel EB, Basile P, Koltz PF, Marcus J, Girotto JA. Current surgical practices in cleft care: cleft palate repair tecnhiques and postoperative care. Plastic and Reconstructive Surgery 2009; 124: 899-906.

8. Bindingnavele VK, Bresnick SD, Urata MM, Huang G, Leland H, Wong D, Hammoudeh J, Reisnich J. Superior results using the islandized hemipalatal flap in palatoplasty: Experience with 500 cases. Plastic and Reconstructive Surgery 2008; 122: 232-239.

9. Kirschner RE, Wong P, Jawad AF, Duran M, Cohen M, Solot C, Randall P, LaRossa D. Cleft palate repair by modified Furlow double-opposing z-plasty: The Children’s Hospital of Philadelphia experience. Plastic and Reconstructive Surgery 1999; 104: 1998-2010.

10. Yamaguchi K, Lonic D, Lee C, Yun C, Lo L. Modified Furlow palatoplasty using small double-opposing z-plasty: surgical technique and outcome. Plastic and Reconstructive Surgery 2016; 137: 1825-1831.

11. Funayama E, Yamamoto Y, Nishizawa N, Mikoya T, Okamoto T, Imai S, Murao N, Furukawa H, Hayashi T,Oyama A. Important points for primary cleft palate repair for speech derived from speech outcome after three types of palatoplasty. International Journal of Paediatric Otorhinolaryngology 2017; 78: 2127-2131.

12. Kim S, Choi TH, Park JH, Kwon G, Kim JC. Influence of modified Furlow double-opposing z-plasty on mandibular growth in Oriental patients with cleft palate and/or lip. Annals of Plastic Surgery 2014;73: 311-314.

13. LaRossa D, Jackson OH, Kirschner RE, Low DW, Solot CB, Cohen MA, Mayro R, Wong P, Minugh-Purvis N, Randall P. The Children’s Hospital of Philadelphia modficiation of the Furlow double-opposing z-plasty: long-term speech and growth results. Clinics in Plastic Surgery 2004; 31: 243-249.

14. Timbang MR et al. A systematic review comparing Furlow double-opposing z-plasty and straight-line intravelar veloplasty methods of cleft palate repair. Plastic and Reconstructive Surgery 2014;134:1014–22.