{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:39:59Z","timestamp":1793716799188,"version":"4.6.1"},"reference-count":51,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate comparative speech and surgical outcomes of Furlow Z-plasty (FZP) versus pharyngeal flap (P Flap) in the primary treatment of submucous cleft palate (SMCP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>PubMed, Embase, MEDLINE, Scopus, and CENTRAL were systematically searched from database inception through June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>\n                      Eight nonrandomized studies including 376 pediatric patients with SMCP (FZP:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009250; P Flap:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009126).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Primary surgical treatment with FZP or P Flap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcomes evaluated were postoperative residual hypernasality (perceptually assessed), velopharyngeal insufficiency (VPI), and reoperation rates. Secondary outcomes included obstructive sleep apnea (OSA) and oronasal fistula formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was no significant difference in residual hypernasality scores between the 2 interventions (odds ratio [OR] 0.88; 95% confidence interval [CI] [0.41-1.92];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.757). However, patients undergoing FZP had significantly higher odds of persistent postoperative VPI (OR 2.36; 95% CI [1.14-4.88];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.020) and reoperation (OR 3.16; 95% CI [1.21-8.22];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.019). Conversely, FZP was associated with a slightly lower risk of OSA (OR 0.11; 95% CI [0.01-1.06];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.056). No difference in postoperative fistula formation was observed between the 2 procedures (OR 1.13; 95% CI [0.11-11.61];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.920).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on the available evidence, P Flap appears to offer more durable speech outcomes than FZP for the primary treatment of SMCP, with significantly lower reoperation rates. However, the potential for increased OSA risk following P Flap highlights the importance of patient-specific surgical planning that balances velopharyngeal function with airway safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261445557","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:55:08Z","timestamp":1778745308000},"page":"4149-4159","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Speech Outcomes Following Furlow Z-Plasty Versus Pharyngeal Flap in the Primary Management of Submucous Cleft Palate"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8786-5246","authenticated-orcid":false,"given":"Jonathan","family":"Mokhtar","sequence":"first","affiliation":[{"name":"Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU-CoM)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo G.","family":"Di Martino","sequence":"additional","affiliation":[{"name":"Centro de Refer\u00eancias para Imunobiol\u00f3gicos Especiais, Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Alhammadi","sequence":"additional","affiliation":[{"name":"Dubai Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaikha","family":"Almarzooqi","sequence":"additional","affiliation":[{"name":"Dubai Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek A.","family":"Mendonca","sequence":"additional","affiliation":[{"name":"Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU-CoM)"},{"name":"Department of Plastic Surgery, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates"},{"name":"Mediclinic City Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn R.","family":"Rogers-Vizena","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital"},{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-6990","authenticated-orcid":false,"given":"Ingrid","family":"Ganske","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital"},{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Meara","sequence":"additional","affiliation":[{"name":"Boston Children's Hospital"},{"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"issue":"3","key":"e_1_3_2_2_2","first-page":"181","article-title":"The occult submucous cleft\u2014improving detection by education","volume":"88","author":"Martin S","year":"2019","unstructured":"Martin S, Slevin E, Hill C. 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