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Predictors of Success in Furlow Palatoplasty for Submucous Clefts: An Experience with 91 Consecutive Patients

Background: The aim of this study was to evaluate, through multivariate ordinal logistic regression, variables contributing to good postoperative speech outcomes following Furlow palatoplasty. Methods: A series of 91 consecutive patients was evaluated. Variables analyzed included demographics; speech perceptual assessment; and measures on videonasopharyngoscopy and videofluoroscopy such as preoperative closure pattern, velopharyngeal gap, and lateral pharyngeal wall motion. Univariate and multivariate analysis of predictors of high scores of articulation, nasal resonance, and resolution of velopharyngeal insufficiency were performed using simple and multinomial logistic regression. A summative perceptual assessment score was generated and analyzed for correlation with postoperative speech outcomes. Results: There were 39 patients (42.9 percent) with a good outcome as defined by adequate articulation and lack of velopharyngeal insufficiency with normal nasal resonance. There was improvement of articulation in 53 patients (58.2 percent), of nasal resonance in 75 patients (82.4 percent), and of velopharyngeal insufficiency in 80 patients (87.9 percent). Predictors of good postoperative speech outcomes (p < 0.05) were preoperative articulation, nasal resonance, and lateral pharyngeal wall movement greater than 37.5 percent on one side. Preoperative severity of velopharyngeal insufficiency, velopharyngeal gap, pattern of closure, age, and sex were not predictive of a good outcome. Logistic regression demonstrated that the preoperative perceptual assessment score was predictive of postoperative outcome, with a significant difference (p < 0.05) between mild and severe groups. Conclusion: A scoring system based on summated perceptual assessment parameters is predictive of good postoperative speech outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.