American Association of Plastic Surgeons Meeting 2022

Single Z-plasty Versus Double-opposing Z-plasty: A Comparison of Success with Palatal Lengthening

Neel Vishwanath, BS1; Julia Lerner, MA1; Vinay Rao, MD, MPH1; Joseph Crozier, MA1; Albert Woo, MD1

Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Background

Palate length is associated with improved speech outcomes in cleft palate repair. The Furlow double-opposing Z-plasty (2ZP) utilizes two Z-plasties to reorient palatal musculature and lengthen the velum. The overlapping intravelarveloplasty (IVV) achieves longitudinal closure of the nasal mucosa with a single oral Z-plasty (1ZP), responsible for lengthening the palate. It has been demonstrated in cadaver study that 1ZP is as effective as the Furlow double-opposing Z-plasty (2ZP) in lengthening the soft palate1. We hypothesize that these 2 closure techniques will result in similar palatal lengthening using clinical pre-and postoperative measurements.

Methods

A retrospective comparative study was conducted of patients undergoing primary repair of the soft palate. All included patients underwent either 2ZP or 1ZP. Pre-and post-operative measurements of the palate were recorded across various dimensions (Figure 1). The primary outcome of interest was anterior-posterior (AP) palatal length. Secondary outcome was posterior pharynx length given that this distance has been shown to vary inversely with palatal lengthening2. Statistical analysis was conducted using the Mann-Whitney-Wilcoxon test for significance.

Results

•80 patients met inclusion criteria (2ZP = 14, 1ZP = 66). There was no significant difference in preoperative palatal length between patients who received 2ZP vs 1ZP (p=0.16)

•Patients who underwent 2ZP exhibited an average increase in palatal length of 7.93 mm (p < 0.05) , and 1ZP an increase of 7.23 mm (p <0.001) (Figure 2).

•Patients who underwent 2ZP exhibited an average decrease in posterior palatal length of -6.71 (p<0.001), and 1ZP a decrease of -9.4 (p<0.0001) (Figure 3)

•AP palatal lengthening was not significantly greater for 1ZP vs 2ZP (15.7% vs 16.2%; P = 0.53) (Table 1)

•1ZP showed greater decrease in posterior pharynx, however this change was not significantly significant (-61.3% vs -36.5%, p = 0.05) (Table 1)

Conclusion

A single oral Z-plasty results in statistically significant palatal lengthening in patients. There was no difference seen in the AP dimension of palate length between 2ZP and 1ZP techniques. The authors advocate the consideration of this approach due to its advantages of avoiding overlapping surgical scars between the nasal and oral sides of the palate, reducing the risk of fistula formation. Additionally, opting for straight-line closure of the nasal mucosa instead of a Z-plasty potentially decreases the operative time and limits handling of a thin, potentially friable mucosal layer.

American Association of Plastic Surgeons Meeting 2022

Single Z-plasty Versus Double-opposing Z-plasty: A Comparison Of Success With Palatal Lengthening

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