Cleft palate repair by double opposing Z-plasty

Area of Science:

• Craniofacial Surgery
• Pediatric Plastic Surgery
• Speech Pathology

Background:

• Cleft palate repair presents challenges in balancing speech development and maxillary growth.
• Velopharyngeal insufficiency (VPI) is a common complication following palate repair.
• Existing techniques may compromise maxillary growth or require secondary procedures.

Purpose of the Study:

• To evaluate a novel palatoplasty technique using opposing Z-plasties for improved speech outcomes.
• To assess the impact of this technique on maxillary growth.
• To determine the incidence of velopharyngeal insufficiency and need for secondary interventions.

Main Methods:

• A palatoplasty utilizing two opposing Z-plasties (oral and nasal layers) was performed on 22 infants with various cleft types.
• The technique involved dissecting and repositioning palatal muscles to create an overlapping sling and lengthen the velum.
• Maxillary growth was considered, and hard palate closure was achieved without pushback or lateral relaxing incisions.

Main Results:

• Of 20 evaluated children, 18 showed no velopharyngeal insufficiency (VPI).
• Two children exhibited very mild VPI.
• No patients required a pharyngeal flap, indicating successful primary speech results.

Conclusions:

• The Z-plasty palatoplasty technique effectively improves speech results in infants with cleft palate.
• This method allows for adequate maxillary growth without compromising velopharyngeal function.
• The technique minimizes the need for secondary surgical interventions like pharyngeal flaps.