Redo double-opposing Z-plasty is effective for correction of marginal velopharyngeal insufficiency

Hsu, Po-Jung; Wang, Shuhui; Yun, Claudia; Lo, Lun-Jou

doi:10.1016/j.bjps.2015.05.014

Cited by 28 publications

(15 citation statements)

References 22 publications

(9 reference statements)

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“…Five of these patients underwent nasopharyngoscopy as part of their postoperative assessment, and a comparison of preoperative and postoperative closure ratios was included as an objective measurement of velopharyngeal function in these 5 patients. While lacking somewhat in objective measures for the postoperative success in the other 8 study patients, the findings of the study by Hsu et al 10 support our conclusions that palatal function is not negatively affected following secondary or revision Furlow repair.…”

Section: Discussionsupporting

confidence: 83%

Palatal Motion After Primary and Secondary Furlow Palatoplasty

Rudnicki

Tsang

Vecchiotti

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Section: Discussionsupporting

confidence: 83%

Palatal Motion After Primary and Secondary Furlow Palatoplasty

Rudnicki

Tsang

Vecchiotti

et al. 2017

JAMA Otolaryngol Head Neck Surg

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“…Over the past few decades, many techniques and procedures have been described and/or revised to address VPI. [14][15][16][17][18][19][20][21][22] Few of these papers postulate an underlying mechanism that pre-disposes a patient to velopharyngeal insufficiency, 3,4,19,20,23 and often the complication is associated with failure to adequately address the levator sling at the time of primary palatoplasty. 19,20 Given the increased burden of care that prolonged speech therapy can impose on families and the relatively high potential for additional speech operations, it would seem prudent to address the concern for VPI at the time of initial repair, particularly in those difficult cases where there is a high likelihood of a poor outcome.…”

Section: Introductionmentioning

confidence: 99%

Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

Thurston

Vargo

Bennett

et al. 2020

FACE

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Objective: The objective of this study was to evaluate the ability of the buccal fat pad flap (BFPF) to fill the void remaining after muscle transposition and study its effect on durability, fistula rate, palatal shortening/contraction, and relapse of muscle positioning in wide and challenging cleft repairs. Design: A retrospective chart review was performed. Charts were abstracted for standard demographics, reason for BFPF utilization, palatal length, palatal fistula, co-morbidities, and speech outcomes. Patients, Participants: Patients under age 3 who underwent primary palatoplasty between October 2007 and September 2015 which utilized a medially placed BFPF were identified. Results: Fifty-three patients were identified. Mean age at palatoplasty was 1.4 (0.78-2.55) years. Mean follow-up was 2.52 (0.02-7.26) years. Twenty-four (45.3%) patients had concerning intraoperative findings warranting flap utilization. Twenty-nine (54.7%) patients underwent BFPF for large dead-space volume. Four patients (7.55%) experienced a fistula. Thirty-nine patients had comments on their palatal length. Of these, 28 (71.8%) were of average length, and 8 (20.5%) were long. Thirty-three patients have undergone formal speech evaluation. Of these, 20 (60.6%) were of normal resonance, and 12 (36.4%) demonstrated nominal hypernasality. No patients have yet to require a secondary speech operation. Conclusion: Use of the BFPF has become more common in our practice particularly in challenging cleft palate repairs. It is a versatile technique addressing large interpositional dead space and thin outer and inner lamellae in the anterior soft palate after posterior muscle transposition. Early results, in difficult repairs, demonstrate excellent durability and that palatal length appears to be maintained, potentially lessening the need for secondary speech surgery.

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“…13 A research stated that although the lavatory muscle sling might be disturbed by the redo DOZ procedure, the surgery was effective in correcting the residual VPI with low morbidity. 14 In a study, Significant improvement of APA and nasalance score for oral and nasal sentences was achieved. Flexible nasopharyngoscopy showed complete velopharyngeal closure in 19 patients (82%) postoperatively.…”

Section: Discussionmentioning

confidence: 97%

Evaluation and Management of Velopharyngeal Incompetence

Srinath¹,

Kishore²,

Reddy³

et al. 2019

IJCMSR

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Palatoplasty for cleft lip and palate is associated with two major complications speech development disorders, including velopharyngeal insufficiency, and maxillary growth disturbance. Current study aimed to assess velopharyngeal incompetence and anatomical factors contributing to incomplete closure following cleft palate repair and to evaluated the patients after the surgical procedure and attempted to recommend an appropriate management strategy. Materials and Methods: A prospective observational study was conducted from January 2011 to January-2013. A total of 28 patients with operated cleft palate having clinical features of velopharyngeal insufficiency were included in the study. Patients were evaluated by history, physical examination, Video fluoroscopy, Nasoendoscopy. Velopharyngeal gap size and closure pattern were taken into account based on the endoscopy report. Velopharyngeal gap size was rated on a four-point scale. Results: Among our study participants, 9 (32%) were aged between 11 to 15 years, and 16 (57%) were males. Out of 28 cases with velopharyngeal incompetence, who were assessed endoscopically, the distribution of closure pattern was circular in 20(72%) cases. There were no patients found with sagittal closure pattern. Conclusion: Our study concluded that Surgical correction of VPI improves speech and patients are advised speech therapy to improve the compensatory articulations.

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Redo double-opposing Z-plasty is effective for correction of marginal velopharyngeal insufficiency

Cited by 28 publications

References 22 publications

Palatal Motion After Primary and Secondary Furlow Palatoplasty

Palatal Motion After Primary and Secondary Furlow Palatoplasty

Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

Evaluation and Management of Velopharyngeal Incompetence

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