Correction of secondary velopharyngeal insufficiency in cleft palate patients with the Furlow palatoplasty.

To avoid the serious complications of pharyngeal flap surgery, a Furlow palatoplasty was used to correct velopharyngeal insufficiency after primary palatoplasty in 18 Chinese cleft palate patients (3 to 23 years old) from 1988 to 1992. The follow-up duration was 1 to 4 years. These patients were selected after a complete study for velopharyngeal insufficiency, including intraoral examination, perceptual speech assessment, videonasopharyngoscopy, and/or multiview videofluoroscopy. The criteria for selection included age, pattern of velopharyngeal closure, size of the velopharyngeal gap, extent of lateral pharyngeal wall movement, existence of a Passavant's ridge, and abnormal levator veli palatini muscle insertion. Complete velopharyngeal closure was achieved for 16 patients after surgery. The majority of these patients (15) had a velopharyngeal gap less than 5 mm. The 2 patients who still had velopharyngeal insufficiency after the surgery had a velopharyngeal gap larger than 10 mm before the surgery. The most important factor seemed to be the size of the velopharyngeal gap. Pattern of velopharyngeal closure or age of the patient also might play an important role. The results showed that a Furlow palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected patients. Although the criteria for the selection of this operation need further study, present results are encouraging.