A Modification of the Furlow Palatoplasty Utilizing Bilateral Buccal Fat Pad Grafts

Tvedt, Dag

Since Leonard Furlow first described the double-reversing z-palatoplasty in 1978, the technique has become a significant treatment option for repairing clefts of the secondary palate. However, there has been difficulties in using this technique for wider clefts (1), and in all repairs, narrow or wide, maximizing the gain in palatal length and volume after palatoplasty.

In the developing world, especially in Africa, there are still many older children (>5year) and adults with wide unrepaired clefts, which poses a considerable challenge for cleft surgeons. It is important to avoid the pharyngeal procedures which represent a higher risk from an anesthetic and immediate post operative perspective, and, as well, associated with an increase in the incidence of sleep apnea.

The use of pedicled buccal fat pad graft is described in different procedures, such as lining a nasal defect in releasing pushback palatoplasty (2).

The authors present a modification of the Furlow palatoplasty utilizing bilateral buccal fad pad grafts. The conventional Furlow technique is followed until the point of final suturing of the oral flap. To prevent compromising the acquired length, the dead space is covered with bilateral buccal fat pad grafts.

This modified technique has been used for the past 4 years in West Africa with promising results. The use of pedicled buccal fat pads allows the lengthening of the palate to be maximized, which also increases the volume of the soft palate. Moreover, the technique also enables wider clefts to be treated with the Furlow technique.

In summary, this modified technique not only allows speech improvement, but also reduces the number of patients that require further correction with different forms of pharyngoplasty.

A step-by-step description with clinical pictures of this modified technique is presented.

1. M. Boseley, S.E. Bevans. Double-Reversing Z-Plasty (Furlow Palatoplasty). Adv Otorhinolaryngol. 2012, 73:145-8.

2. P.X.Pinto, S. Debnath. Use of Pedicled Graft of Buccal Fat Pad to Line a Nasal Defect in Releasing Pushback Palatoplasty. Br J Oral Maxillofac Surg. 2007 Apr;45(3):249-50.