Simultaneous double-opposing Z-plasty and posterior pharyngeal flap

J Oral Maxillofac Surg. 2014 Apr;72(4):803.e1-6. doi: 10.1016/j.joms.2013.11.027. Epub 2013 Dec 6.


Purpose: 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.

Materials and 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.

MeSH terms

  • Child
  • Cleft Palate / surgery
  • Deglutition / physiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Nose / physiopathology
  • Palate, Soft / surgery
  • Pharynx / surgery*
  • Plastic Surgery Procedures / methods*
  • Speech / physiology
  • Surgical Flaps / surgery*
  • Velopharyngeal Insufficiency / surgery
  • Voice / physiology