Comparison of Speech Outcomes Following Furlow Z-Plasty Versus Pharyngeal Flap in the Primary Management of Submucous Cleft Palate.
Jonathan Mokhtar, Lorenzo G Di Martino, Fatima Alhammadi et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared primary Furlow Z-plasty (FZP) with pharyngeal flap surgery in children with submucous cleft palate. It included eight nonrandomized studies and 376 patients. Residual hypernasality did not differ significantly between procedures. FZP was associated with higher odds of persistent postoperative velopharyngeal insufficiency (OR 2.36; 95% CI [1.14-4.88]; P = .020) and reoperation (OR 3.16; 95% CI [1.21-8.22]; P = .019). The authors concluded that pharyngeal flap may provide more durable speech outcomes, while noting potential airway risk.
Key findings
- Residual hypernasality scores did not differ significantly between FZP and pharyngeal flap (OR 0.88; 95% CI [0.41-1.92]; P = .757).
- FZP was associated with higher odds of persistent postoperative VPI (OR 2.36; 95% CI [1.14-4.88]; P = .020).
- Reoperation odds were higher after FZP than pharyngeal flap (OR 3.16; 95% CI [1.21-8.22]; P = .019).
- FZP showed a slightly lower OSA risk, but the difference was not significant (OR 0.11; 95% CI [0.01-1.06]; P = .056).
Why it matters
The findings highlight a trade-off in primary surgical management of submucous cleft palate: pharyngeal flap was associated with fewer persistent VPI outcomes and reoperations, whereas FZP may carry less risk of obstructive sleep apnea. Considering both speech function and airway outcomes is important when interpreting comparative surgical evidence.
What to keep in mind
The meta-analysis included only eight nonrandomized studies, so treatment comparisons may be affected by differences between patient groups and study methods.