Cleft Palate Repair by Double Opposing Z-Plasty

TLDR

The study aimed to improve speech outcomes and preserve maxillary growth by performing a palatoplasty with two opposing Z‑plasty layers in 22 infants. The procedure was performed on 22 infants (8 unilateral, 8 bilateral, 6 isolated cleft palate) using two opposing Z‑plasty incisions that redirect palatal muscles to form an overlapping sling and lengthen the velum without hard palate tissue. Of the 20 children old enough for speech evaluation, 18 had no velopharyngeal insufficiency, two had very mild insufficiency, and none required a pharyngeal flap.

Abstract

In an attempt to improve speech results following palate repair while allowing adequate maxillary growth, a palatoplasty using two opposing Z-plasties of the soft palate, one of the oral and one of the nasal layers, has been used in 22 infants. Eight patients had unilateral cleft lip and palate, eight had bilateral cleft lip and palate, and six had cleft palate. The Z-plasties facilitate effective dissection and redirection of the palatal muscles to produce an overlapping muscle sling and lengthen the velum without using tissue from the hard palate, which permits hard palate closure without pushback or lateral relaxing incisions. Of the 20 children old enough for speech evaluation, 18 have no velopharyngeal insufficiency. Two have very mild velopharyngeal insufficiency. None has required a pharyngeal flap.