xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

Plastic and Reconstructive Surgery • February 2024

Fig. 8. Furlow palatoplasty. ( Above , left ) Incisions for the Furlow palatoplasty are designed with the medial cleft margin serving as the long limb of the Z-plasty and the oblique incisions on the oral mucosa serving as the short limb of the Z-plasty. The posteriorly based flap must incorporate the levator muscle as it will be transposed posteriorly and allow for anatomical muscle realign ment. The anteriorly based flap must only include oral mucosa and leave the muscle down to be included in the posteriorly based nasal myomucosal flap for posterior transposition to recreate the levator sling. ( Above , right ) The posteriorly based oral myomucosal flap is elevated and the anteriorly based oral mucosa only flap is elevated. An opposing Z-plasty is designed on the nasal layer. The posteriorly based nasal flap must incorporate the levator muscle. The anteriorly based nasal flap must only consist of mucosa, leaving all of the levator muscle with the oral layer. ( Below , left ) Nasal layer flaps are transposed in Z-plasty fashion and closed with suture. The levator muscle on the posteriorly based nasal myomucosal flap is realigned from an aberrant sagittal orientation to an anatomical transverse configuration. ( Below , right ) Oral layer flaps are transposed in Z-plasty fashion and closed with suture. The levator muscle on the posteriorly based oral myomucosal flap is realigned from an aberrant sagittal orientation to an anatomical transverse configuration, completing the levator sling and the Furlow repair. [Reprinted with permission from van Aalst JA, Kolappa KK, Sadove M. MOC-PSSM CME article: nonsyndromic cleft palate. Plast Reconstr Surg . 2008;121(Suppl):1–14.]

Given the heterogeneity in cleft palate research, it is a challenge to compare outcomes data. A recent systematic review compared Furlow Z-plasty to straight-line intravelar veloplasty and found soft palate repairs with Furlow Z-plasty had improved speech outcomes and fewer secondary velopharyn geal insufficiency (VPI) operations. 60 The difference

in outcomes, however, cannot be fully extrapolated because of the systematic review’s omission of radi cal, more modern intravelar veloplasty techniques in their analysis. A retrospective study by Kara et al. found no difference when comparing speech out comes between Furlow Z-plasty and type 2b intrave lar veloplasty (radical levator dissection). 61

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