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This one is about: Flap vs. Furlow (vs. Sphincter Pharyngeoplasty)

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Pharyngeal Flap vs. Furlow (vs Sphincter Pharyngeoplasty)

A member of cleft-talk mentioned that her baby's ENT commented that she would have a Pharyngeal Flap done because her palate is so wide. She asked what is the difference between the (pharyngeal) flap and the furlow.

Below is our answer:

Well, first of all, a Pharyngeal flap is not done because a cleft is WIDE -- it's done because a palate is SHORT -- and it is only one of three (main) possible procedures done to lengthen a palate.

When they do a pharyngeal flap, they use a rectangle of tissue from the pharyngeal wall to build an artificial non-normative structure that bridges the distance that the soft palate has to cross to close off during speech. They leave ports to the side to allow air through while breathing. This artificial structure has been very effective in reducing nasality in speech, but it comes at a price. Because of the artificial ledge, bacteria tend to easily get caught there and you will likely see an increase in throat infections. More seriously, though - the flap can create a sleep apnea problem that COULD be potentially life-threatening. Now, that is an extreme, to say the least, but because of the threat, no child should ever have a flap without first having a battery of tests. Videoflouroscopy, Nasoendoscopy, and/or nasopharyngoscopy would tell the doctor how much closure the child is achieving prior to the surgery. A sleep study will help to predict the degree of risk of apnea.

The Furlow is also called a "double reversing Z-plasty" and is completely different from the flap. This technique builds length and flexibility, while not creating an artificial structure. As with everything, though, there are still drawbacks. For instance, the Furlow will not help if the problem is that the musculature is not working right. And the Furlow can create a palate that is too long. Probably the biggest drawback is that the Furlow is fairly new still and requires special training -- so it is simply not available in some places.

The third option is called a Sphincter Pharyngeoplasty. This is another case of building an artificial structure -- they turn and re-attach mucosa in the pharyngeal area to create a sphincter where there was not one. This sphincter acts like a drawstring to help close off the airway during speech. It is such a new technique that I don't know a lot about it. I understand that it is a good choice when the musculature is not working correctly. And, from those parents who have had this done on their little ones, it seems to have a satisfactory affect on nasal speech. I am pretty sure it is not practiced everywhere, however.

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