title: Repeat Double-Opposing Z-Plasty for the Management of Persistent Velopharyngeal Insufficiency.
abstract: BACKGROUND
  Persistent velopharyngeal insufficiency occurrence after double-opposing Z-plasty has been treated with either posterior pharyngeal flap or sphincteroplasty. Both these methods can be accompanied by mild discomfort, such as mouth breathing and hyponasal resonance, and can lead to severe complications, such as sleep apnea and upper airway compromise. The purpose of this study was to review the efficacy of repeat double-opposing Z-plasty for the management of persistent velopharyngeal insufficiency in patients who received a prior surgical intervention by double-opposing Z-plasty.
  
  
  METHODS
  All patients who were treated by repeat double-opposing Z-plasty between January 2000 and December 2014 were reviewed. Patient demographics, cleft type, surgical technique, and complications, such as wound dehiscence, infection, fistula, and upper airway obstruction, were evaluated. Preoperative and postoperative speech evaluations were reviewed for comparison.
  
  
  RESULTS
  Fourteen patients underwent repeat double-opposing Z-plasty, with an average follow-up of 34 months. There was no complication including wound dehiscence, flap necrosis, fistula, or upper airway compromise. Velopharyngeal competence (resonance, nasal emission, intraoral pressure, social/personal problems) was significantly improved postoperatively (P < 0.05). Only 1 patient required posterior pharyngeal flap for persistent velopharyngeal insufficiency.
  
  
  CONCLUSIONS
  Repeat double-opposing Z-plasty is an effective and safe surgical strategy for the management of persistent velopharyngeal insufficiency, in patients who received a prior surgical intervention by double-opposing Z-plasty. This strategy allows speech improvement and reduces the risk of postoperative upper airway compromise.
authors.affiliation: From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Tae Suk
authors.initials: TS
authors.lastname: Oh
authors.forename: Kyung S
authors.initials: KS
authors.lastname: Koh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010160:Palate, Soft / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D055815:Young Adult