(1018) Furlow vs von Langenbeck Palatoplasty in Children with Cleft Palate: A Systematic Review and Meta-Analysis

Introduction: Furlow double-opposing Z-plasty and von Langenbeck palatoplasty are among the most common surgical procedures to treat children with cleft palate. The present study compares the efficacy of both techniques, with particular emphasis on the incidence of oronasal fistula (ONF).

Methods: A Systematic Review and Meta-Analysis comparing the outcomes of Furlow and von Langenbeck palatoplasty in children with Cleft Palate was conducted from May to November 2025. Relevant studies were identified through a systematic search on PubMed, Cochrane, Scopus and Embase databases. Outcomes included ONF incidence, velopharyngeal insufficiency (VPI), hypernasality, and nasal air emission. Categorical results were expressed using Risk Ratio (RR) with 95% confidence intervals (95% CI). Statistical analyses were conducted using the R Software with a p < 0.05 considered for statistical significance. Heterogeneity was assessed using the I² statistic.

Results: Seven studies were included in the meta-analysis, comprising a total of 1,035 patients. No significant difference in ONF was found between the Furlow and von Langenbeck techniques (RR 0.88; 95% CI 0.42–1.82; p=0.73). Similarly, no statistical difference was observed in hypernasality (RR 0.40; 95% CI 0.11–1.50; p=0.08) or nasal air emission (RR 0.57; 95% CI 0.11–3.04; p=0.19). Furlow palatoplasty, however, incurred in lower rates of VPI when compared to the von Langenbeck technique (RR 0.22; 95% CI 0.02–2.50; p=0.05).

Conclusions: While both techniques yield comparable results for ONF, hypernasality, and nasal air emission, Furlow palatoplasty appears superior in reducing VPI. These findings support its preferential use when optimal velopharyngeal function is a surgical priority.