The correction of velopharyngeal insufficiency by Furlow palatoplasty in patients older than 3 years undergoing Veau-Wardill-Kilner palatoplasty: a prospective clinical study.

Background: Velopharyngeal insufficiency may persist after primary repair of the palate. This insufficiency causes a speech deficit. Although there are many treatment alternatives, the most effective treatment of velopharyngeal insufficiency remains controversial.

Methods: The authors performed Furlow palatoplasty in patients older than 3 years who had undergone primary palatoplasty with the Veau-Wardill-Kilner technique. Speech was assessed by a speech therapist before and after the operation. Velopharyngeal closure and velum motion were recorded using a video nasendoscope before and also 12 months after the operation. Any increase in velum length was measured.

Results: After Furlow palatoplasty, 10 of 27 patients (37 percent) made complete recovery and 12 (44 percent) made substantial recovery from hypernasal resonance, but five (18.5 percent) showed no improvement. Regarding nasal emission, 16 of 27 patients (59.3 percent) made complete and eight (29.6 percent) made substantial recovery, but there was no change in three (11 percent). Five of 27 patients (18.5 percent) achieved complete intelligibility and 18 of 27 (66.7 percent) improved intelligibility, but four (14.8 percent) did not show any improvement in intelligibility. Articulation improved considerably in 17 of 27 (63 percent). The overall rate of surgical success and near misses who benefited from the surgery was 18 of 27 (67 percent), and a positive correlation between surgical success and articulation and intelligibility was noticed. Video nasendoscopy showed complete velopharyngeal closure in 15 of 27 patients (56 percent). The mean velar length increased by 44 percent. After secondary Furlow palatoplasty, patients with small gaps benefited more.

Conclusions: The results suggest that Furlow palatoplasty performed in later years improves not only speech but also velopharyngeal closure by reorienting the levator veli palatini muscle and augmenting the velum.