Furlow's double Z-plasty is a convenient procedure for cleft palate repair

ABSTRACT

The present study aimed to evaluate and compare the surgical outcome of Von Langenbeck and Furlow's procedures for repair of primary cleft palate. The study included 22 children with mean age of 16.5 +/- 3.1 months allocated into 2 equal groups Group A underwent Von Langenbeck procedure and Group B underwent Furlow's procedure. Von Langenbeck palatoplasty involved elevation of large mucoperiosteal flaps from the hard palate and side-to-side approximation of the cleft margins of both soft and hard palates with detachment of the levator muscles from their bony insertions and the use of long relaxing lateral incisions without lengthening maneuver. Furlow's procedure involved Z-plasty incision with the cleft is the central limb, lateral limbs end over the hamuli, transposition of the posteriorly based nasal Z-plasty flap brings the palatal muscle posteriorly and across the cleft, insetting the anteriorly based Z-plasty flap closes the front of the soft and hard palates. Then, oral Z-plasty flaps were transposed to overlap the palatal muscles creating a palatal muscle sling. The cleft width, length increase in the soft palate, length of Z-plasty, the frequency of the need for hamulus fracture, duration of surgery and intraoperative blood loss were recorded. The postoperative distance between last molar tooth and the uvula was determined and compared versus preoperative one. Both procedures provided a significant increase of the length of distance between last molar and uvula, with a significant increase of length in group B compared to group A. All patients in group A required relaxing incision irrespective of the preoperative cleft width; while only 2 of patients in group B [18.2%] required relaxing incision with a significant difference in favor of group B. Mean length of Z-plasty incision required in group B was 1.5 +/- 0.17; range 1.1-1.7 cm. Mean operative time was significantly shorter in group A [76.8 +/- 10.6 min] compared to group B [91.8 +/- 13.1 min] and Furlow's procedure was associated with significantly more blood loss compared to Von Langenbeck procedure. One patient [9.1%] in group B had small fistula, but no patient had wound dehiscence; while in group A, one patient had wound dehiscence and another had oronasal fistula with a postoperative complication rate of 18.2%. It could be concluded that Furlow's palatoplasty improves the outcome of cleft palate repair irrespective of the width of the cleft with acceptable complication rate and significant lengthening of the uvula