The Effect of Zigzag Palatoplasty on the Repair of Cleft Palate and its Comparative Study With Sommerlad Palatoplasty and the Double Opposing Z Palatoplasty

Abstract

Purpose: At present, there are a variety of surgical methods for cleft palate repair, the authors first created the zigzag plasty of nasal mucosa musculature. The method is characteristic of better repair effect for anatomy and function of palatopharyngeal compared with the traditional method. Methods: Fifty patients with cleft palate were involved in this study, and treated with 3 different operative methods, respectively: zigzag palatoplasty for the repair of nasal mucosa myometrium (n = 17), Sommerlad palatoplasty (n = 18) and the double opposing Z palatoplasty (n = 15), respectively. The length of soft palate (the distance from incisor to the tip of uvula) and the distance from uvula to posterior pharynx before and after operation were selected as outcome index. The post-operative speech intelligibility, nasal resonance, and nasal leaking were also evaluated. Results: The results showed that the lengths of soft palate were increased by 14.50%, 13.23%, 10.10% with the zigzag palatoplasty, the double opposing Z palatoplasty and Sommerlad palatoplasty, respectively; the distances from the vertical tip to the posterior pharyngeal wall of 3 kinds of operation were reduced by 49.03%, 47.78%, 49.03%, respectively. The comparison of speech intelligibility, nasal resonance and nasal resonance assessment between/among groups were not significant. Conclusion: The authors’ research showed that the effect of zigzag palatoplasty works well in the repair of nasal mucosa myometrium and can be used as an optional method for functional repair of cleft palate.

Comparison of velopharyngeal morphology of two palatoplasty techniques in patients with hard and soft cleft palate

“…Nevertheless, Furlow palatoplasty not only restored the velar muscular sling to proper orientation but also elongated the velar length reducing the risk of longitudinal scar contracture. Consequently, the Furlow repair has a stronger ability to extend the soft palate length than sommerlad palatoplasty (18). After 289 patients with cleft palate repaired by Furlow palatoplasty, Chorney et al (27) found only 5% of the patients needed secondary surgery as a result of VPI.…”

“…The former was by means of dissection and reposition of the levator veli palatini, while the latter was achieved with the help of the double-opposing Z-plasty. Previously, several studies had evaluated the clinical outcomes of these two surgical procedures (16)(17)(18)(19)(20). Khosla et al reported Furlow Z-plasty yielded excellent speech results for primary cleft palate repair, and the rate of VPC reached 84% (16).…”

“…Khosla et al reported Furlow Z-plasty yielded excellent speech results for primary cleft palate repair, and the rate of VPC reached 84% (16). According to Wang et al, 80% patients with Sommerlad palatoplasty had no evidence of velopharyngeal insufficiency (18). In addition, Li et al compared the incidence of postoperative fistula formation of the above two techniques and found that the fistula rate of Furlow palatoplasty is lower than that of Sommerlad palatoplasty (19).…”

“…However, few research have been conducted to compare the velopharyngeal morphology between Furlow and Sommerlad techniques. If any, they were assessed only using subjective evaluation methods (18). Thus, the current study aims to compare velopharyngeal morphology and speech outcomes using subjective and objective parameters after cleft palate repair with Furlow or Sommerlad palatoplasty, to provide clinical evidence for a better choice of surgical methods to reconstruct a functional velopharyngeal unit and restore optimal speech in patients with HSCP.…”

Primary Palatoplasty: A Comparison of Results by Various Techniques - A Retrospective Study

“…Wang et al . [ 25 ] introduced a new modification to lengthen the soft palate by making a multiple zigzag incision in the nasal mucosa which is named zigzag plasty. Their study showed a good lengthening of the soft palate than compared to other methods.…”