Plast Reconstr Surg. 2026 Mar 17. doi: 10.1097/PRS.0000000000013045. Online ahead of print.
ABSTRACT
BACKGROUND: Patients with cleft lip and/or palate have a significantly higher prevalence of sleep-disordered breathing (SDB) due to congenital anatomic differences and the sequelae of surgical management. Of note, the velopharyngeal and oropharyngeal airway size plays a significant role. This single-center retrospective study compares the effect of conventional Furlow palatoplasty and small-Z Furlow palatoplasty on airway morphology.
METHODS: Consecutive patients with cleft lip and alveolus (CL/A) and cleft lip and palate (CL/P) presenting for secondary alveolar bone grafting (ABG) between 2017-2019 were enrolled for this study. Exclusion criteria included syndromic patients, previous secondary velopharyngeal surgery, and previous sleep surgery. Patients were divided into the control group (CL/A only), those who received primary conventional Furlow palatoplasty, and those who received primary small-Z palatoplasty. Speech was assessed by 2 experienced speech pathologists and SDB via the OSA-18 questionnaire. Airway and velum morphology was assessed using cone beam CT.
RESULTS: Amongst the 95 included patients, 23 were in the control group, 32 had conventional Furlow palatoplasty, and 40 patients had small-Z Furlow palatoplasty. There was no statistically significant difference in speech outcomes or OSA-18 scores between the 3 groups. However, compared to the conventional group, the small-Z group demonstrated increased velopharyngeal airway volume, decreased velar length and increased minimum cross-section area of the velopharyngeal airway.
CONCLUSION: Conventional and small-Z Furlow palatoplasty provided patients with a similar speech and sleep quality outcome. The small-Z palatoplasty, however, demonstrated an increased velopharyngeal airway volume and minimum cross-section area, as well as decreased velar length.
PMID:41843915 | DOI:10.1097/PRS.0000000000013045