Does Early Two-stage Palatoplasty Using the Modified Furlow Technique Lead to Favorable Maxillofacial Growth?

• Published in: Journal of Japanese Cleft Palate Association Vol. 47; no. 1; pp. 1 - 10
• Main Author: NISHIO, Juntaro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Cleft Palate Association 2022; 一般社団法人 日本口蓋裂学会
• Subjects: craniofacial growth; early two-stage palatoplasty protocol; Furlow’s technique; Furlow法; unilateral complete cleft lip and palate; 早期二期的口蓋裂手術; 片側唇顎口蓋裂; 顎発育
• ISSN: 0386-5185; 2186-5701
• DOI: 10.11224/cleftpalate.47.1

Purpose: To minimize the deteriorative effect of palatal surgery on maxillary growth, intensive debates concerning treatment protocols have long focused on the timing and procedure of cleft palate surgery. Combining the concepts of early two-stage regimens and Furlow’s palatoplasty, we have developed an early two-stage protocol （ETS）, which consists of soft palate closure at 12 months of age with modified Furlow’s palatoplasty and hard palate closure at 18 months of age for children with complete unilateral cleft lip and palate. We have already reported on the long-term outcomes of this treatment protocol. In this paper, we summarize them and discuss the usefulness of this treatment in terms of craniofacial growth compared with the conventional pushback palatoplasty （PB）. Material and methods: The subjects enrolled in the present article had non-syndromic complete unilateral cleft lip and palate, and were being consecutively treated at the Department of Oral and Maxillofacial Surgery, Osaka Women’s and Children’s Hospital. Dental model analysis was conducted at the age of 4 years on 72 children （32 of the ETS group, 40 of the PB group）, and cephalometric analysis was performed on 68 male children （37 of the ETS group, 31 of the PB group） at the ages of 10 and 15 years. Results: At 4 years of age, the anteroposterior and transversal distances of the ETS group were significantly longer than those of the PB group. In an assessment of the dental arch relationships using the 5-year-olds’ index, good dental arch relations were found in 48.2％ of the ETS group and in 8.0％ of the PB group. In the cephalometric analysis, the ETS group showed a significantly larger maxillary length and a shorter mandibular body, resulting in a greater A-N-B value, compared with the PB group. The ETS group also showed a shorter posterior vertical maxillary length than the PB group. Conclusions: The long-term results showed that the early two-stage palatoplasty protocol using modified Furlow’s palatoplasty for patients with unilateral complete cleft lip and palate is advantageous regarding the maxillomandibular relationship compared with pushback palatoplasty.