A Systematic Review Comparing Furlow Double-Opposing Z-Plasty and Straight-Line Intravelar Veloplasty Methods of Cleft Palate Repair

Background: A systematic review was conducted to compare the speech outcomes and fistula rates following repair of the cleft palate with Furlow double-opposing Z-plasty and straight-line intravelar veloplasty techniques. Methods: A systematic search of the English literature published in the MEDLINE, Ovid, and Embase electronic databases was performed using the following keywords: cleft palate, intravelar veloplasty, velopharyngeal insufficiency, and speech outcome. The exclusion criteria were as follows: syndromic patients, no description or poor description of the technique used, data not stratified by cleft palate type, two-stage cleft palate repair, average age at repair younger than 9 months or older than 18 months, and age at the last follow-up younger than 4 years. Statistical analysis was used to compare the rate of secondary operations and the incidence of velopharyngeal insufficiency. Results: Twelve studies satisfied the inclusion criteria. In the isolated cleft palate group, the mean failure rates were 9.7 and 16.5 percent for Furlow double-opposing Z-plasty and straight-line intravelar veloplasty closure, respectively. In the unilateral cleft lip-cleft palate group, the mean failure rates were 11.1 and 17.1 percent for Furlow and straight-line intravelar veloplasty closure, respectively. The difference in the odds of requiring secondary surgery in the straight-line intravelar veloplasty repair group versus the Furlow group was statistically significant (p = 0.03) in unilateral cleft lip-cleft palate. Conclusion: This systematic review indicated an increased incidence of velopharyngeal insufficiency as revealed by higher odds of secondary operations in the straight-line intravelar veloplasty repair of unilateral cleft lip-cleft palate when compared with Furlow Z-plasty.