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Original Investigation
October 06, 2016

Palatal Motion After Primary and Secondary Furlow Palatoplasty

Author Affiliations
  • 1Tufts University School of Medicine, Boston, Massachusetts
  • 2Department of Otolaryngology–Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
  • 3Department of Pediatric Otolaryngology and Facial Plastic Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. Published online October 6, 2016. doi:10.1001/jamaoto.2016.2783
Abstract

Importance  Indications for Furlow palatoplasty include primary repair of cleft palate as well as secondary repair, or secondary palatoplasty for treatment of velopharyngeal insufficiency. Speculation exists surrounding the benefit of secondary Furlow palatoplasty in cases of a previously well-reconstructed palate or a short but otherwise anatomically normal soft palate because it has been theorized that reorientation of a previously reconstructed or normal muscular levator sling should in fact worsen palatal motion.

Objective  To compare palatal motion following primary and secondary Furlow palatoplasty using footage from postoperative nasopharyngoscopy videos.

Design, Setting, and Participants  In this retrospective case series, medical records in a database of an urban academic pediatric otolaryngology practice was used to identify patients who had undergone either primary or secondary Furlow palatoplasty. Subjects with adequate postoperative nasopharyngoscopy footage were randomized, and 2 blinded reviewers assessed soft palate motion in each video using an abbreviated version of the Golding-Kushner scale.

Main Outcomes and Measures  Reviewers' blinded ratings of soft palate motion were quantified using a modified Golding-Kushner scale to generate a mean palatal motion score for each subject (range, 0.0-2.0). Scores of primary and secondary Furlow palatoplasty patients were compared.

Results  Over a 4-year period, 20 patients with adequate postoperative nasopharyngoscopy footage were identified (12 primary Furlow palatoplasty patients and 8 secondary Furlow palatoplasty patients). Patients consisted of 8 males and 12 females and ranged in age from 12 months to 22 years at the time of postoperative nasopharyngoscopy. Modified Golding-Kushner scores were similar between groups: mean primary group, 1.61 (range, 0.5-2.0); mean secondary group, 1.53 (range, 0.75-2.0); absolute difference in mean, 0.08 (95% CI, 0.00-0.43); effect size, Hedges g, 0.18. There was fair interrater reliability (interclass coefficient, R = 0.45), consistent with prior reports using this scale. No significant difference in postoperative palatal motion scores was identified between primary and secondary palatoplasty groups in this study.

Conclusions and Relevance  When examined in isolation, postoperative motion of the soft palate appears similar following both primary and secondary Furlow palatoplasty procedures, suggesting that there are no major deleterious effects on palatal motion following secondary Furlow palatoplasty.

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