Faculty, Staff and Student Publications

Language

English

Publication Date

1-1-2025

Journal

American Journal of Otolaryngology

DOI

10.1016/j.amjoto.2025.104610

PMID

40107158

Abstract

Background: In patients with cleft palate (CP), the impact of primary palatoplasty technique on otologic outcomes remains a major point of contention. While some studies report improved outcomes after certain techniques of palatal repair, there is a lack of consensus on the most effective procedure.

Objective: We sought to characterize the effects of primary palatoplasty technique on otologic outcomes in children with CP.

Methods: A single institution retrospective review of patients with CP who underwent primary palatoplasty (straight-line repair or Furlow Z-plasty) was performed. Primary outcomes of interest included time to placement of T-tubes, number of tympanostomy tube placements, tympanic membrane (TM) perforation, and 3-year and 6-year postoperative hearing thresholds.

Results: A total of 140 patients were included in this study. The mean number of tympanostomy tube placements in the straight-line repair group (1.93 ± 1.28) was significantly higher than in the Furlow Z-plasty group (1.42 ± 1.03, p = 0.03). Median time from primary palate repair to T-tube placement was 38.93 (IQR 33.03) months. Higher birth weight (p < 0.01) and multiple tympanostomy tube placements (p < 0.05) were associated with longer time to T-tube placement. T-tube replacement was associated with a 16.9 times higher likelihood of TM perforation (p < 0.05). The median PTA significantly improved from 16.25 (IQR 7) dB at 3 years to 11.00 (IQR 5.25) dB at 6 years (p < 0.01).

Conclusions: Furlow palatoplasty technique was associated with fewer number of tympanostomy tube placements; however, palatoplasty technique did not significantly impact time to T-tube placement, TM perforation, or hearing outcomes. There were no significant differences in long-term hearing outcomes between patients who underwent Furlow Z-plasty and those who had straight-line repair. Most patients achieved normal hearing thresholds by 6 years after primary palatoplasty and tympanostomy tube placement. These are important considerations to discuss when counseling patients' families on surgical management of CP and otologic outcomes.

Keywords

Humans, Cleft Palate, Retrospective Studies, Female, Male, Middle Ear Ventilation, Treatment Outcome, Child, Preschool, Plastic Surgery Procedures, Infant, Child, Tympanic Membrane Perforation, Cleft palate, Hearing outcome, Otologic outcome, Palatoplasty technique

Published Open-Access

yes

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