Cleft Palate Repair Guided by Cleft Gap: An Institutional Protocol Using Modified Asymmetric Short Limb Z-plasty...

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Craniofacial Surgery

Background:

• Optimal soft palate repair for cleft palate varies with cleft width and configuration.
• Wide gaps may cause tension with standard Z-plasty, while narrow gaps might not need complex intravelar veloplasty (IVV).

Purpose of the Study:

• To introduce and evaluate an institutional protocol for selecting cleft palate repair techniques based on intraoperative measurements.
• To compare outcomes of algorithm-driven technique selection versus a single approach.

Main Methods:

• Developed a protocol using intraoperative cleft gap measurement at the uvular neck.
• Applied modified asymmetric small limb Z-plasty (MASLZ) for V-shaped gaps ≤ 6 mm.
• Used straight-line repair (SLR) with overlapping IVV for wider or U-shaped gaps.

Main Results:

• In 65 patients, fistula formation and need for secondary velopharyngeal insufficiency (VPI) surgery were comparable between MASLZ and SLR groups.
• Surgical technique was not an independent predictor of secondary VPI surgery in multivariable analysis.

Conclusions:

• Individualized, algorithm-driven technique selection in palatoplasty leads to consistent outcomes.
• This approach avoids the uniform application of a single method, adapting to specific cleft characteristics.