The Impact of Palatal Dimensions on Speech: Exploring Associations Between Velopharyngeal Insufficiency and Conversion Furlow Palatoplasty

Background: One of the major goals of palatoplasty is restoration of the ability to produce socially acceptable speech. Despite technique refinements, many patients will go on to need secondary surgeries to correct hypernasal speech. Furlow palatoplasty is successful in treating secondary velopharyngeal insufficiency (VPI), as shown by many previous studies, however there have been no studies examining the relationship between the palatal dimension changes with secondary Furlow palatoplasty and the success in correcting VPI. Methods: All patients that underwent major revision palatoplasty (CPT code 42215) from 2012 to 2022 were evaluated. Patients were screened for Furlow palatoplasty. Pre- and postoperative palate length, hypernasal score, and speech score using Pittsburgh Weighted Speech Score (PWSS) were acquired and the Furlow Z-plasty angle was calculated. Results: Thirty-three patients met inclusion criteria. Average age at time of revision surgery was 9.6 years old. The average length of follow up was 25.2 ± 19.7 months. Average increase in palate length was 10.7 mm (66.9%). Average decrease in palate height was 10.2 mm. Average decrease in hypernasality score was 1.8. Average Furlow Z-plasty angle was 58.5°. A successful outcome (hypernasal score of 0 or 1) was achieved in 88% of patients following surgery and 82% of patients achieved resolution of hypernasality (hypernasal score of 0). Neither change nor absolute palate length had any correlation on hypernasal score change or speech score change ( P > .05). Conclusion: Conversion Furlow palatoplasty achieves excellent rates of improved hypernasality and improvement in speech. Achieved palatal dimensions did not impact resolution of hypernasality or numerical change in speech score. Our study suggests that conversion Furlow palatoplasty is successful in treating VPI regardless of the dimensions of the Z-plasty.