Result of the Management of Velopharyngeal Insufficiency with Double Opposing Z-plasty. An 11-year experience of a Single Surgeon

Result of the Management of Velopharyngeal Insufficiency with Double Opposing Z-plasty. An 11-year experience of a Single Surgeon

Cheng Chun Wu M.D., Chien Chung Chen M.D., Ching Hsiang Yang M.D., Faye Huang M.D., Yi Lin Tsai, Jui Pin Lai M.D.

Craniofacial Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine, Taiwan

Background

  To correct the velopharyngeal insufficiency (VPI) in patient with cleft palate and get better speech outcome, lots of methods have been discussed and published. Furlow double opposing Z-plasty has been a popular procedure. In this study, we reported our result of Furlow double opposing Z plasty of a single surgeon in 11-year-period. Besides, we also described an end-to-end repair of levator veli palatine and compared the result with traditional overlap repair.  

Patients and methods

  The charts of patients diagnosed and treated as VPI from Jan, 2004 to Dec, 2014 were reviewed retrospectively. All the patients who underwent previous primary two flap palatoplasty presenting with VPI were included. Patients who initially presented with submucal cleft palate and VPI were also included. Patients who were diagnosed with syndromic cleft palate were excluded. Preoperative velopharyngeal (VP ) gap was determined by nasopharyngeal scope(NPS), and preoperative and postoperative speech assessments were performed by speech therapist. The patients without adequate follow up were also excluded. The data was analyzed and compared.

Results

One hundred and sixty-nine patients were reviewed and 103 patients were included in this study. The operations were all performed by the senior author (Lai). The overall velopharyngeal competence (VPC) rate was 79.7% postoperatively while 80.4% in end-to-end group and 72.3% in overlap group. (P>0.05) No patients presented with inadequate VP closure. There were 23.3% patients with marginal VP closure, 75.7 % patients with normal resonance, 23.3% patients with mild hypernasality. Only one patient still had moderate hypernasality.

Conclusion

Most of our patient with mild VPI had great improvement in VP closure postoperatively. The patients with moderate VPI also had much improvement although the results were not as good as patients of mild VPI. End-to-end method could be a good way for levator veli palatine repair. It provided a three-layer repair and the result was similar or even better to overlap method.