Furlw vs 2 flap on ET function.pptx

COMPARATIVE STUDY:
EFFECT OF TWO DIFFERENT PALATOPLASTY
TECHNIQUES ON HEARING OUTCOME.
(MODIFIED FURLOW VS. TWO-FLAP TECHNIQUE)
By
Mahmoud Sobhy Allam
Assistant Lecturer of Maxillofacial Surgery - General Surgery
Department
Sohag University
2024
Submitted For Fulfillment of Medical Doctorate Degree in General Surgery

Under supervision
Prof. Dr. Kamal Abd El-Aal Mohamed Hassanein
Professor of Maxillofacial, Head and Neck, and General Surgery
Department of General Surgery, laparoscopic, and Oncological Surgery
Faculty of Medicine, Sohag University
Prof. Dr. Samir Ahmed Abdelmagid
Professor of General Surgery
Prof. Dr. Mamdouh Mohamed Abou-El Hassan
Professor of Pediatric Plastic Surgery, Plastic surgery Division, Department of General
Surgery, Faculty of Medicine, Cairo University

Examiners committee
Prof. Dr. Kamal Abd El-Aal Mohamed Hassanein
Professor of Maxillofacial, Head and Neck, and General Surgery
Prof. Dr. Salah El- Deen Shaltot
Professor of Maxillofacial Surgery
Department of General Surgery
Faculty of Medicine, Asuit University
Prof. Dr. Ahmed Gaber Hasanien
Professor of Maxillofacial, Head and Neck surgery

Dedication
To My Family; My Mother Spirit, My Father Spirit , My Wife and
my children

Introduction
CLP represents a major public health problem due to
 associated life-long morbidity
 complex aetiology.
 It is debilitating condition that is associated with
significant feeding, hearing, speech, and
psychological impairments.
 The wide surgical, dental, speech, social, and
medical involvement

 Children with CP have been reported to suffer from
an increased frequency of middle ear disease and
ensuing hearing loss, which is almost universal.

 Hearing problems in CLP could also be influenced
by several factors such as the patient's age, gender,
ethnicity, type of repair, and types of cleft pathology.

 Many techniques for palatal closure have been
described, but the most effective surgical technique
continues to be undetermined.
 An important factor that could affect the Otitis Media
of CP repair concerning middle ear function and
speech is the technique of Palatoplasty.
Unfortunately, this remains a major point of
contention.

 Many researches discussed outcome of different
palatoplasties but few of them concerned about ET
function and middle ear normalization

Aim of the work
 Our work investigated the effect of Modified Furlow
Palatoplasty versus Two flaps Palatoplasty on the
ET function and hearing outcome in patients with
CP.

Patients and methods
 prospective study was conducted on CP patients
 From january 2020 to September 2023
 at the Plastic Surgery Division in Al-kasr Alini
Hospitals - Cairo University and Maxillofacial, Head
and Neck Surgery Unit, Department of General
Surgery, laparoscopic, and Oncological Surgery -
Sohag University.

 Ethical considerations:
 This research has been revised by
The Scientific Ethical Committee of
Sohag University Hospital and was
conducted in accordance with the
principles of Helsinki as modified in
2014.
The legal guardians of the patients
signed an informed written consent.

 The patients were divided into two groups;
Group 1 : were treated by modified Furlow.
Group 2: were treated by two flaps palatoplasty
technique.

Inclusion criteria:
Age more than 6 months and less
than 7 years.
All cases with cleft palate.
1ry cases
Weight more than 10 pounds.
Hb level more than 10 g dl.
Non-syndromic cases.

Exclusion criteria included:
Age more than 7 years, less than 6 months
CP cases with
o Sensorineural hearing loss,
o Ossicular chain abnormalities,
o Ear anomaly patients,
Submucosal CP.
Syndromic cases.
2ry cases.
Medically compromised cases.

Pre-operative evaluation:
 History taking;
oAge
o gender
oType of cleft

Pre-operative evaluation:
Ear condition:
• the occurrence of middle ear disease
• the number of episodes of OM
• periods with hearing loss
• possible treatment with ventilating tubes
o The tympanic membrane examinations were
performed using otoscope, and by tympanometry

o Detection of other congenital anomalies.
oOther medical problems.

Veau (1931) classification was used to
classify our cases.
I. Clefts of the soft palate
II. Clefts of the soft and hard palate, up to
the incisive foramen.
III. Clefts of the soft and hard palate
extending unilaterally through the alveolus.
IV. Clefts of the soft and hard palate
extending bilaterally through alveolus

Operative technique:
 Modified Furlow Palatoplasty
(standard technique with buccinator
myomucosal flap modification)

Operative technique:
 Tow flap technique

Ventilation tubes
 Not routinely indicated before Palatoplasty.
 post-operative indication :
persistent type B or C pneumatic pressure
tympanogram after two trials of treatment over 6
months.
recurrent acute Otitis Media (greater than 5
infections in a year).
effusions Lasting more than 3–6 months or a
documented conductive hearing loss.

Pressure Tympanogram
 Welch-Allyn
Diagnostics Inc., USA.
 Tympanograms were
divided into the
following types:
1.type A (+99 to −99
mm H2O)
2.type B (flat curve
without an identifiable
peak).
3.type C (>100 mm
H2O)

Follow up
 patients were followed-up for First 6 months at
regular visits after one week post-operative, 3
weeks, one month, 3 months, and then 6 months till
one year.
 Assessment of middle ear effusion, OM, ET
dysfunction and number of VT used.

Follow up
Pressure Tympanogram was done one month post-
operative routinely,
 if it was normal, it would not be repeated.
 If tympanometry was abnormal, medical treatment
was prescribed and the test was repeated after 3
months.

RESULTS
 This study included 72 patients with CP.
 35 (48.6%) males, 37(51.4%) females.
 age range: from 12 months, to 84 months (7y).
 mean age : 39.49 ± 19.286 months.

RESULTS
The patients were divided into two groups;
 In group (1) : there were 21 males (50%) and 21
females (21
 group (2) : there were 14 Male (46.7%), 16
Female (53.3%).

Pre & post-operative ear evaluation
Time of ear
evaluation
variable Group 1
(42)
Group 2
(30)
P Value
Preoperative Effusion 37(88.1%) 24(80%) NOT Significant
0.18
Otitis Media 2(4.8%) 3(10%)
Normal 3(7.1%) 3(10%)
One month
post-operative
Effusion 36(85.7%) 20(66.6%) NOT Significant
0.101
Otitis Media 1(2.4%) 4(13.3%)
Normal 5(11.9%) 6(20%)
3 months post-
operative
Effusion 30(71.4%) 17(56.7%) Significant
0.004
Otitis Media 2(4.8%) 10(33.3%)
Normal 10(23.8%) 3(10%)
6 months post-
operative
Effusion 31(73.8%) 15(50%) NOT Significant
0.012
Otitis Media 0 5(16.7%)
Normal 11(15.3%) 10(33.3%)
0ne year post-
operative
0.142
Normal 17(40.5%) 8(26.7%)

Time of ear
evaluation
variable Group 1
(42)
Group 2
(30)
P Value
Preoperative Effusion 37(88.1%) 24(80%) NOT Significant
0.18
Normal 3(7.1%) 3(10%)
One month
post-operative
0.101
Otitis Media 1(2.4%) 4(13.3%)
Normal 5(11.9%) 6(20%)
3 months post-
operative
0.004
Otitis Media 2(4.8%) 10(33.3%)
Normal 10(23.8%) 3(10%)
6 months post-
operative
0.012
Normal 11(15.3%) 10(33.3%)
0ne year post-
operative
0.142
Normal 17(40.5%) 8(26.7%)

Time of ear
evaluation
variable Group 1
(42)
Group 2
(30)
P Value
Preoperative Effusion 37(88.1%) 24(80%)
NOT Significant
0.18
Normal 3(7.1%) 3(10%)
One month
post-operative
0.101
Otitis Media 1(2.4%) 4(13.3%)
Normal 5(11.9%) 6(20%)
3 months post-
operative
0.004
Otitis Media 2(4.8%) 10(33.3%)
Normal 10(23.8%) 3(10%)
6 months post-
operative
0.012
Normal 11(15.3%) 10(33.3%)
0ne year post-
operative
0.142
Normal 17(40.5%) 8(26.7%)

Time of ear
evaluation
variable Group 1
(42)
Group 2
(30)
P Value
NOT Significant
0.18
Normal 3(7.1%) 3(10%)
One month post-
operative
0.101
Otitis Media 1(2.4%) 4(13.3%)
Normal 5(11.9%) 6(20%)
3 months post-
operative
0.004
Otitis Media 2(4.8%) 10(33.3%)
Normal 10(23.8%) 3(10%)
6 months post-
operative
0.012
Normal 11(15.3%) 10(33.3%)
0ne year post-
operative
0.142
Normal 17(40.5%) 8(26.7%)

Time of ear
evaluation
variable Group 1
(42)
Group 2
(30)
P Value
NOT Significant
0.18
Normal 3(7.1%) 3(10%)
One month
post-operative
0.101
Otitis Media 1(2.4%) 4(13.3%)
Normal 5(11.9%) 6(20%)
3 months post-
operative
0.004
Otitis Media 2(4.8%) 10(33.3%)
Normal 10(23.8%) 3(10%)
6 months
post-operative
0.012
Normal 11(15.3%) 10(33.3%)
0ne year post-
operative
0.142
Normal 17(40.5%) 8(26.7%)

VT insertion
The gain of our study
 Out of 72 pt. we spared 36% of non
indicated routine insertion of VT ,

Conclusion
 hearing affection and otitis media in
CP, are not affected by the severity of
cleft type.
 Without C P repair, hearing affection is
unavoidable.
 Repair of CP improves ET
dysfunction.

Conclusion
 Modified Furlow shows early improvement of ET
dysfunction and middle ear condition, but has no
superiority after one year over two flaps
Palatoplasty.
 The Modified Furlow and tow flaps Palatoplasty
procedures show significant effect as regard
decreasing the severity of hearing loss and ET
dysfunction.

Conclusion
 conservative management of middle ear instead of
prophylactic tube insertion is recommended .

Furlw vs 2 flap on ET function.pptx

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