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Furlow's Double Z-Plasty Is a Convenient
Procedure for Cleft Palate Repair
Ahmed El-Kady, Kassem Kassem , Hossam Abdel Aziem ,
Abou-Bakr Ras
Department of Otorhinolaryngology, Faculty of Medicine, Benha
University
Tanta Med. Sc. J 2007; 2(3):5-12
Article type: Original article
Aim: The present study aimed to evaluate and compare the surgical
outcome of Von Langenbeck and Furlow's procedures for repair of
primary cleft palate. Patients & Methods: 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. Results: 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%. Conclusion: 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. |