Pros and cons of the Sommerlad and Furlow palate repair techniques

The Furlow double opposing Z-plasty first introduced by Dr. Leonard Furlow and Sommerlad repair with intravelar veloplasty (IVVP) initially described by Dr. Brian Sommerlad have both grown in popularity since their conception and are now the two most popular techniques for cleft palate repair. Both have been demonstrated to be safe and effective techniques for cleft palate repair, and while many surgeons have a strong preference for either the Furlow or Sommerlad technique, no definitive study exists demonstrating superiority of one over the other as each method of repair is accompanied by its own unique list of pros and cons. For example, though the Furlow repair is known for its profound ability to lengthen the soft palate, this type of repair is not as effective when utilized in the context of a wide cleft palate. Likewise, while the Sommerlad IVVP fully repairs the velar muscular sling and potentially reduces velopharyngeal insufficiency (VPI), the straight midline scar produced can limit palatal movement. This manuscript will review the introductory and existing literature for each technique, discuss anatomic differences between the two approaches, and point out particular strengths and weaknesses of both repair methodologies. This is a level 4 clinical evidence expert summary based on non-systematic reviews of the literature.