Comparative Analysis of Airway Volume and Velum Morphology in Primary Furlow Palatoplasty: Conventional vs. Small-Z Design.

Abstract

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. 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. 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. 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.