title: Redo double-opposing Z-plasty is effective for correction of marginal velopharyngeal insufficiency.
abstract: OBJECTIVE
  Double-opposing Z-plasty (DOZ) of the Furlow method has been successfully used for the correction of marginal velopharyngeal insufficiency (VPI) by reconstructing the levator muscle and lengthening the soft palate. For a recurrent or residual marginal VPI, it was questioned whether redo DOZ could be applied to correct the problem and minimize surgical morbidity. This study reported the outcome of the redo DOZ.
  
  
  METHODS
  The DOZ procedure was the method of choice for marginal VPI in the authors' center. To evaluate the effectiveness of the redo operation, patients with cleft palate with or without cleft lip treated from 2005 to 2014 were reviewed. Inclusion criteria were non-syndromic patients who underwent the second DOZ for the correction of marginal VPI. Clinical information, speech assessment, and nasopharyngoscopic findings were reviewed.
  
  
  RESULTS
  The velopharyngeal function was improved from marginal to adequate in all 13 patients either subjectively or objectively. The resonance became normal in nine patients after the surgery, and the change was statistically significant. Preoperative audible nasal emission improved in four out of five patients. Complications were minor or transient including one patient with snoring. No patient complained of airway or sleep problems.
  
  
  CONCLUSIONS
  Although the levator muscle sling might be disturbed by the redo DOZ procedure, the surgery was effective in correcting the residual VPI with low morbidity.
authors.affiliation: Medical School of Chang Gung University, Taoyuan, Taiwan.
authors.forename: Po-Jung
authors.initials: PJ
authors.lastname: Hsu
authors.affiliation: Speech Pathologist in the Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Speech Pathologist in the Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Claudia
authors.initials: C
authors.lastname: Yun
authors.affiliation: Plastic and Reconstructive Surgery, Craniofacial Center, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: lunjoulo@cgmh.org.tw.
authors.forename: Lun-Jou
authors.initials: LJ
authors.lastname: Lo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000175:diagnosis / Q000601:surgery; D002972:Cleft Palate / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010160:Palate, Soft / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013065:Speech Intelligibility; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013624:Taiwan; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Cleft palate; Double-opposing Z-plasty; Furlow palatoplasty; Velopharyngeal insufficiency