Management of Velopharyngeal Insufficiency Using Double Opposing Z-Plasty in Patients Undergoing Primary Two-Flap Palatoplasty

Background Velopharyngeal insufficiency (VPI) may persist after primary repair of the cleftpalate, and surgical correction is necessary in many cases. The purpose of this study is toevaluate the effect of double opposing Z-plasty (DOZ) in cleft palate patients suffering fromVPI after primary two-flap palatoplasty.Methods Between March 1999 and August 2005, we identified 82 patients who underwenttwo-flap palatoplasty for cleft palate repair. After excluding the patients with congenitalsyndrome and mental retardation, 13 patients were included in the final study group. Theaverage age of the patients who underwent DOZ at was 5 years and 1 month. Resonance,nasal emission, and articulation were evaluated by a speech pathologist. The velopharyngealgaps were measured before and after surgery.Results Six patients attained normal speech capabilities after DOZ. The hypernasality gradewas significantly improved after surgery in all of the patients (P=0.0015). Whereas nasalemission disappeared in 8 patients (61.5%), it was diminished but still persisted in the remaining5 patients. Articulation was improved in all of the cases. In two cases, the velopharyngeal gapwas measured using a ruler. The gap decreased from 11.5 to 7 mm in one case, and from 12.5 to8 mm in the second case.Conclusions The use of DOZ as a surgical option to correct VPI has many advantages comparedwith other procedures. These include short surgery time, few troublesome complications, and noharmful effects on the dynamic physiological functioning of the pharynx. This study shows thatDOZ can be another option for surgical treatment of patients with VPI after two-flap palatoplasty.