nach oben

European Journal of Plastic Surgery

Erschienen in:

01.12.2024 | Original Paper

Systematic review and meta-analysis of speech outcome among different surgical techniques post cleft palate repair: Furlow against other palatoplasty techniques

verfasst von: Muhannad Q. Alqirnas, Abdulaziz S. Almosa, Salman Sufian Qasim, Hanan Alhusainan

Erschienen in: European Journal of Plastic Surgery | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Background

A cleft palate is a congenital condition in which the palate has an opening that can be on either one or both sides of the roof of the mouth and vary in size. Different surgical techniques are used to correct cleft palate. The choice of surgical approach for cleft palate repair relies on the nature and size of the aperture as well as the surgeon’s experience and preferences. The current systematic review and meta-analysis’s main goal was to evaluate and compare the efficacy of various cleft palate surgical procedures.

Methods

The databases of PubMed, ScienceDirect, and Google Scholar were searched for English papers having online complete texts. Preclinical studies, abstracts, theses, editorials, commentaries, meta-analyses, systematic reviews, and evidence synthesis were all disregarded. A prevalence meta-analysis and subgroup analysis were carried out with the use of Stata and the Meta XL statistical software.

Results

Medline, Google Scholar, and PubMed were among the databases searched. A first search revealed 3059 studies. Only 2562 studies remained after duplicates were eliminated. The abstracts and titles of the articles were skimmed. 266 papers were examined after being cut based on predetermined eligibility criteria. Finally, 36 articles were found to have successfully met the eligibility requirements.

Conclusions

Furlow palatoplasty was superior to other procedures in terms of incidence of velopharyngeal insufficiency. The effectiveness of techniques for speech based on fistula formation was Bardach, Furlow, Wardill-Kilner then von Langenbeck. The one stage palatoplasty was superior to the two-stage approach in terms of fistula formation and velopharyngeal insufficiency.

Level of evidence: Not ratable

Agrawal K (2009) Cleft palate repair and variations. Indian J Plast Surg 42:S102–S109. https://doi.org/10.1055/S-0039-1699382CrossRefPubMedPubMedCentral

Canfield MA, Honein MA, Yuskiv N et al (2006) National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999–2001. Birth Defects Res A Clin Mol Teratol 76:747–756. https://doi.org/10.1002/BDRA.20294CrossRefPubMed

Campbell A, Costello BJ, Ruiz RL (2010) Cleft lip and palate surgery: an update of clinical outcomes for primary repair. Oral Maxillofac Surg Clin North Am 22:43–58. https://doi.org/10.1016/J.COMS.2009.11.003CrossRefPubMed

LaRossa D (2000) The state of the art in cleft palate surgery. Cleft Palate Craniofac J 37(3):225–228. https://doi.org/10.1597/1545-1569_2000_037_0225_tsotai_2.3.co_2

Eliason MJ, Hadford S, Green L, Reeves T (2020) Incidence of fistula formation and velopharyngeal insufficiency in early versus standard cleft palate repair. J Craniofac Surg 31:980–982. https://doi.org/10.1097/SCS.0000000000006307CrossRefPubMed

Gustafsson C, Vuola P, Leikola J, Heliövaara A (2020) Pierre robin sequence: incidence of speech-correcting surgeries and fistula formation. Cleft Palate Craniofac J 57:344–351. https://doi.org/10.1177/1055665619874991CrossRefPubMed

Pitkanen VV, Geneid A, Saarikko AM et al (2023) Diagnosing and managing velopharyngeal insufficiency in patients with cleft palate after primary palatoplasty. J Craniofac Surg. https://doi.org/10.1097/SCS.0000000000009822CrossRefPubMedPubMedCentral

Kummer AW (2011) Perceptual assessment of resonance and velopharyngeal function. Semin Speech Lang 32:159–167. https://doi.org/10.1055/S-0031-1277718/ID/32/BIBCrossRefPubMed

Kara M, Calis M, Kara I et al (2021) Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate. J Cranio-Maxillofacial Surg 49:215–222. https://doi.org/10.1016/J.JCMS.2021.01.003CrossRef

10.

Spauwen PHM, Goorhuis-Brouwer SM, Schutte HK (1992) Cleft palate repair: Furlow versus von Langenbeck. J Cranio-Maxillofacial Surg 20:18–20. https://doi.org/10.1016/S1010-5182(05)80190-8CrossRef

11.

Correction of secondary velopharyngeal insufficiency in clef... : plastic and reconstructive surgery. https://journals.lww.com/plasreconsurg/Abstract/1994/12000/Correction_of_Secondary_Velopharyngeal.5.aspx. Accessed 7 Jul 2023

12.

Deren O, Ayhan M, Tuncel A et al (2005) The correction of velopharyngeal insufficiency by Furlow palatoplasty in patients older than 3 years undergoing Veau-Wardill-Kilner palatoplasty: a prospective clinical study. Plast Reconstr Surg 116:85–93. https://doi.org/10.1097/01.PRS.0000169714.38796.ADCrossRefPubMed

13.

Kirschner RE, Wang P, Jawad AF et al (1999) Cleft-palate repair by modified Furlow double-opposing Z-plasty: the Children’s Hospital of Philadelphia experience. Plast Reconstr Surg 104:1998–2010. https://doi.org/10.1097/00006534-199912000-00009CrossRefPubMed

14.

Chan EKW, Lee KH, Tsui BSY et al (2014) From von Langenbeck to Furlow palatoplasty: a 16-year review of cleft palate repair. Surg Pract 18:67–71. https://doi.org/10.1111/1744-1633.12054CrossRef

15.

Randag AC, Dreise MM, Ruettermann M (2014) Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure. Int J Pediatr Otorhinolaryngol 78:1903–1907. https://doi.org/10.1016/J.IJPORL.2014.08.021CrossRefPubMed

16.

Koh KS, Kim SC, Oh TS (2013) Management of velopharyngeal insufficiency using double opposing z-plasty in patients undergoing primary two-flap palatoplasty. Arch Plast Surg 40:97–103. https://doi.org/10.5999/APS.2013.40.2.97CrossRefPubMedPubMedCentral

17.

Seagle MB, Patti CS, Williams WN, Wood VD (1999) Submucous cleft palate: a 10-year series. Ann Plast Surg 42:142–148. https://doi.org/10.1097/00000637-199902000-00006CrossRefPubMed

18.

Farzaneh F, Lindman R, Becker M et al (2009) von Langenbeck procedures at 8 months or Wardill at 18 months for primary repair of cleft palate in adult Swedish patients with unilateral complete cleft lip and palate: a study of facial growth. 42:67–76. https://doi.org/10.1080/02844310701850512

19.

Dong Y, Dong F, Zhang X et al (2012) An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure. Int J Oral Maxillofac Surg 41:604–611. https://doi.org/10.1016/j.ijom.2012.01.010CrossRefPubMed

20.

Wójcicki P, Wójcicka G (2008) The management of velopharyngeal insufficiency with Furlow double-opposing Z-plasty procedure. Eur J Plast Surg 31:115–121. https://doi.org/10.1007/S00238-008-0254-Y/METRICSCrossRef

21.

Williams WN, Seagle MB, Pegoraro-Krook MI et al (2011) Prospective clinical trial comparing outcome measures between furlow and von langenbeck palatoplasties for UCLP. Ann Plast Surg 66:154–163. https://doi.org/10.1097/SAP.0B013E3181D60763CrossRefPubMed

22.

De Mey A, Franck D, Cuylits N et al (2009) Early one-stage repair of complete unilateral cleft lip and palate. J Craniofac Surg 20:1723–1728. https://doi.org/10.1097/SCS.0B013E3181B3EF71CrossRefPubMed

23.

Becker M, Svensson H, McWilliam J et al (2009) Adult skeletal profile in isolated cleft palate: a comparison of the von langenbeck and wardill procedures for primary repair of the palate. 35:387–397. https://doi.org/10.1080/028443101317149354

24.

Sullivan SR, Vasudavan S, Marrinan EM, Mulliken JB (2011) Submucous cleft palate and velopharyngeal insufficiency: comparison of speech outcomes using three operative techniques by one surgeon. 48:561–570. https://doi.org/10.1597/09-127

25.

Holtmann B, Wray RC, Weeks PM (1984) A comparison of three techniques of palatorrhaphy: early speech results. Ann Plast Surg 12:514–518. https://doi.org/10.1097/00000637-198406000-00004CrossRefPubMed

26.

Brothers DB, Dalston RW, Peterson HD, Lawrence WT (1995) Comparison of the Furlow double-opposing Z-palatoplasty with the Wardill-Kilner procedure for isolated clefts of the soft palate. Plast Reconstr Surg 95:969–977. https://doi.org/10.1097/00006534-199505000-00003CrossRefPubMed

27.

Liao YF, Noordhoff MS, Huang CS et al (2004) Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency. Cleft Palate Craniofac J 41:152–156. https://doi.org/10.1597/02-162CrossRefPubMed

28.

Dec W, Shetye PR, Grayson BH et al (2013) Incidence of oronasal fistula formation after nasoalveolar molding and primary cleft repair. J Craniofac Surg 24:57–61. https://doi.org/10.1097/SCS.0B013E31826D09B5CrossRefPubMed

29.

Holland S, Gabbay JS, Heller JB et al (2007) Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. Plast Reconstr Surg 119:1302–1310. https://doi.org/10.1097/01.PRS.0000258518.81309.70CrossRefPubMed

30.

Ravishanker R (2006) Furlow’s palatoplasty for cleft palate repair. Med J Armed Forces India 62:239. https://doi.org/10.1016/S0377-1237(06)80010-9CrossRefPubMed

31.

Losken HW, Van Aalst JA, Teotia SS et al (2011) Achieving Low cleft palate fistula rates: surgical results and techniques. 48:312–320. https://doi.org/10.1597/08-288

32.

Yun SP, De Chalain T (2008) Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. 45:172–178. https://doi.org/10.1597/06-205.1

33.

Pradel W, Senf D, Mai R et al (2009) One-stage palate repair improves speech outcome and early maxillary growth in patients with cleft lip and palate. J Physiol Pharmacol 60(Suppl 8):37–41PubMed

34.

Yamanishi T, Nishio J, Sako M et al (2011) Early two-stage double opposing z-plasty or one-stage push-back palatoplasty?: comparisons in maxillary development and speech outcome at 4 years of age. Ann Plast Surg 66:148–153. https://doi.org/10.1097/SAP.0B013E3181D6E426CrossRefPubMed

35.

Kahraman A, Yuce S, Kocak OF et al (2014) Comparison of the fistula risk associated with rotation palatoplasty and conventional palatoplasty for cleft palate repair. J Craniofac Surg 25:1728–1733. https://doi.org/10.1097/SCS.0000000000000967CrossRefPubMed

36.

Woo AS, Skolnick GB, Sachanandani NS, Grames LM (2014) Evaluation of two palate repair techniques for the surgical management of velopharyngeal insufficiency. Plast Reconstr Surg 134:588e–596e. https://doi.org/10.1097/PRS.0000000000000506CrossRefPubMed

37.

Gunther E, Wisser JR, Cohen MA, Brown AS (1998) Palatoplasty: Furlow’s double reversing Z-plasty versus intravelar veloplasty. 35:546–549. https://doi.org/10.1597/1545-1569_1998_035_0546_PFSDRZ_2.3.CO_2

38.

Yuan N, Dorafshar AH, Follmar KE et al (2016) Effects of cleft width and veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. Ann Plast Surg 76:406–410. https://doi.org/10.1097/SAP.0000000000000407CrossRefPubMed

39.

Deshpande GS, Campbell A, Jagtap R et al (2014) Early complications after cleft palate repair: a multivariate statistical analysis of 709 patients. J Craniofac Surg 25:1614–1618. https://doi.org/10.1097/SCS.0000000000001113CrossRefPubMed

40.

Karsten DA, Larson DM, Larson DO (2003) Dental occlusion after Veau-Wardill-Kilner versus minimal incision technique repair of isolated clefts of the hard and soft palate. 40:504–510. https://doi.org/10.1597/1545-1569_2003_040_0504_DOAVVM_2.0.CO_2

41.

Basta MN, Silvestre J, Stransky C et al (2014) A 35-year experience with syndromic cleft palate repair: operative outcomes and long-term speech function. Ann Plast Surg 73:S130–S135. https://doi.org/10.1097/SAP.0000000000000286CrossRefPubMed

42.

Rohrich RJ, Rowsell AR, Johns DF et al (1996) Timing of hard palatal closure: a critical long-term analysis. Plast Reconstr Surg 98:236–246. https://doi.org/10.1097/00006534-199608000-00005CrossRefPubMed

43.

Grobbelaar AO, Hudso DA, Fernandes DB, Lentin R (1995) Speech results after repair of the cleft soft palate. Plast Reconstr Surg 95:1150–1154. https://doi.org/10.1097/00006534-199506000-00002CrossRefPubMed

44.

Vedung S (1995) Pharyngeal flaps after one- and two-stage repair of the cleft palate: a 25-year review of 520 patients. Cleft Palate Craniofac J 32:206–216. https://doi.org/10.1597/1545-1569_1995_032_0206_PFAOAT_2.3.CO_2CrossRefPubMed

Titel: Systematic review and meta-analysis of speech outcome among different surgical techniques post cleft palate repair: Furlow against other palatoplasty techniques
verfasst von: Muhannad Q. Alqirnas
Abdulaziz S. Almosa
Salman Sufian Qasim
Hanan Alhusainan
Publikationsdatum: 01.12.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Plastic Surgery / Ausgabe 1/2024
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-024-02198-x

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Systematic review and meta-analysis of speech outcome among different surgical techniques post cleft palate repair: Furlow against other palatoplasty techniques

Abstract

Background

Methods

Results

Conclusions

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2024

Potential benefits of adipose–derived SVF and MSCs to regenerate damaged tissues from alloplastic synthetic materials

Three-dimensional scanning for breast plastic and reconstructive surgery: An updated review

Superficial temporal and occipital arteries in free flap scalp reconstruction: anatomical and radiologic study

Breast striae in aesthetic surgery – a novel technique for management

Regenerative peripheral nerve interface in the prevention and treatment of post-amputation pain: a systematic review

Do we practice what we teach: assessing trauma-informed breast exams in breast surgery literature

Update Chirurgie