Simultaneous double-opposing Z-plasty and posterior pharyngeal flap.
OBJECTIVE
Strategies to address severe anteroposterior palatal shortening with velopharyngeal insufficiency include palatal lengthening or manipulation of posterior pharyngeal tissue as a flap or sphincter. In some cases, a single procedure alone is not sufficient to achieve dynamic velopharyngeal closure. The objective of this study was to determine whether double-opposing Z-plasty coupled with a posterior pharyngeal flap would achieve adequate palatal length in severe velopharyngeal dysfunction.


METHODS
Six patients, 3 with previously unrepaired cleft palate and 3 children with previous straight-line repairs and significant anteroposterior shortening, were included. Demographic and perioperative information was tabulated. Subjective and objective speech data were gathered, if available. Complications, follow-ups, and postoperative nasometric results were compiled. Statistical analysis involved the paired t test.


RESULTS
There were no perioperative complications. Follow-up was at least 1 year. No postoperative fistulas or nasal obstruction developed. Hypernasal speech and nasal emission were subjectively improved in all patients. Nasometric data showed a statistically significant improvement in nasal air escape with speech.


CONCLUSIONS
Simultaneous double-opposing Z-plasty and posterior pharyngeal flap can be performed effectively. This strategy is useful for severe velopharyngeal dysfunction secondary to anteroposterior palatal shortening or a previously unrepaired cleft palate, and the technique optimizes palatal function and creates a mechanical blockade to nasal air escape.
Craniofacial Fellow, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
Philipp
P
Metzler
Professor, Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
David W
DW
Low
Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
Gerhard S
GS
Mundinger
Director of Craniofacial Program, Department of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT. Electronic address: derek.steinbacher@gmail.com.
Derek M
DM
Steinbacher
D002648:Child; D002972:Cleft Palate / Q000601:surgery; D003679:Deglutition / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009666:Nose / Q000503:physiopathology; D010160:Palate, Soft / Q000601:surgery; D010614:Pharynx / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013060:Speech / Q000502:physiology; D013524:Surgical Flaps / Q000601:surgery*; D014681:Velopharyngeal Insufficiency / Q000601:surgery; D014831:Voice / Q000502:physiology