Double-Opposing Z-Plasty for Velopharyngeal Insufficiency: Technical Advancements and Outcomes

Furlow's double-opposing Z-plasty (DOZ) can be used to effectively treat velopharyngeal insufficiency (VPI) with minimal complications, but its success rate remains modest. This article presents modifications made to improve DOZ outcomes.

This retrospective study included 114 patients with marginal VPI who had undergone DOZ performed by a single senior surgeon between 2007 and 2024. Patients with a closure ratio of ≥0.7 on nasopharyngoscopy were selected for this study. The DOZ procedure was modified to maximize soft palate lengthening and include fat grafting. Patients were stratified into 3 groups by the version of the procedure performed: first-, second-, and third-generation techniques.

The mean age at surgery was 12.45 ± 7.74 years. Before surgery, the average closure ratio was 0.81. No significant between-group differences were observed in the closure ratio or preoperative velopharyngeal function. The success rates were 80.43%, 88.64%, and 100% for the first-generation (original), second-generation (modified lengthening technique), and third-generation (addition of fat grafting) techniques, respectively. The modified procedure significantly improved velopharyngeal function. No airway obstructions or sleep disturbances were reported.

In the correction of marginal VPI, the modified DOZ procedure incorporating soft palate lengthening and fat grafting may yield optimal outcomes.