Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2023; 56(02): 112-117
DOI: 10.1055/s-0043-1762905
Original Article

Hybrid Palatoplasty: A Simplified DOZ (Double Opposing Z Plasty) with Palatal Myoplasty for Primary Palate Repair

Mukunda Reddy Damalachervu
1   Basavatarakam Smile Train Centre, Department of Plastic & Reconstructive Surgery, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
,
Rajesh Yellinedi
1   Basavatarakam Smile Train Centre, Department of Plastic & Reconstructive Surgery, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
,
Rambabu Nuvvula
1   Basavatarakam Smile Train Centre, Department of Plastic & Reconstructive Surgery, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
,
Dharanipriya A.
1   Basavatarakam Smile Train Centre, Department of Plastic & Reconstructive Surgery, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Surgical techniques for soft palate repair aiming for zero velopharyngeal insufficiency (VPI) are still not achieved. Straight line closure of the soft palate by various techniques of intravelar veloplasty (IVVP) leads to higher incidence of VPI due to scar contracture. Furlow's Z plasty has long, narrow, thin mucosal flaps and mucomuscular flaps with malaligned muscle closure. We present a technique of “hybrid palatoplasty” which borrows from and adds to the existing methods, is robust, is easy to replicate, and results in normal speech consistently.

Aim (1) To design a technique of “hybrid palatoplasty”—combining double opposing Z (DOZ) plasty and IVVP, which is applicable to all types of cleft palate. (2) To evaluate the results of cleft palate children operated using the technique of “hybrid palatoplasty” from 2014 to 2015 in terms of surgical complications (fistulae and dehiscence) and incidence of VPI.

Methods Our procedure combines aspects of both DOZ and IVVP. It is simplified with design of smaller Z plasties. On one side, from the oral Z plasty muscle is dissected off and sutured to the nasal mucomuscular flap of the opposite side to complete the palatal sling. Oral Z plasty is purely mucosal and reverse of the nasal side. A total of 123 cases, operated below 5 years of age were followed up. Speech was assessed by direct evaluation and tele-evaluation.

Results A total of 123 cases, below 5 years of age, were operated between 2014 and 2016 with at least 5 years of follow-up. Note that 120 had normal speech, and 3 had VPI of which 2 were subsequently corrected and went on to develop normal speech.

Conclusion This novel “hybrid palatoplasty” is a simple technique with good speech outcome as it combines the principles of Z plasty and direct muscle repair with palatal sling formation.

Keywords

palatoplasty - Furlow's Z plasty - intravelar veloplasty


Publication History

Article published online:
13 April 2023

© 2023. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Agrawal K. Classification of cleft lip and palate: an Indian perspective. J Cleft Lip Palate Craniofacial Anomalies 2014; 1: 78-84
    CrossrefGoogle Scholar
  • 2 Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone JE, Whitehill TL. Speech Parameters Group. Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate Craniofac J 2008; 45 (01) 1-17
    CrossrefPubMedGoogle Scholar
  • 3 Furlow Jr LT. Cleft palate repair by double opposing Z-plasty. Plast Reconstr Surg 1986; 78 (06) 724-738
    CrossrefPubMedGoogle Scholar
  • 4 Huang MH, Riski JE, Cohen SR, Simms CA, Burstein FD. An anatomic evaluation of the Furlow double opposing Z-plasty technique of cleft palate repair. Ann Acad Med Singap 1999; 28 (05) 672-676
    PubMedGoogle Scholar
  • 5 Chang BL, Yu JW, Nikonova E, Low DW, Taylor JA, Jackson O. Palatal measurements pre- and post-Furlow cleft palate repair: analysis of palatal lengthening and comparison within cleft types. Cleft Palate Craniofac J 2019; 56 (05) 601-609
    CrossrefPubMedGoogle Scholar
  • 6 Guneren E, Uysal OA. The quantitative evaluation of palatal elongation after Furlow palatoplasty. J Oral Maxillofac Surg 2004; 62 (04) 446-450
    CrossrefPubMedGoogle Scholar
  • 7 Randall P, LaRossa D, McWilliams BJ, Cohen M, Solot C, Jawad AF. Palatal length in cleft palate as a predictor of speech outcome. Plast Reconstr Surg 2000; 106 (06) 1254-1259 , discussion 1260–1261
    CrossrefPubMedGoogle Scholar
  • 8 Subtelny JD. A cephalometric study of the growth of the soft palate. Plast Reconstr Surg 1957; 19 (01) 49-62
    CrossrefPubMedGoogle Scholar
  • 9 Chen KT, Noordhoff SM. Experience with Furlow palatoplasty. Changge-ng Yi-xue Zazhi 1994; 17 (03) 211-219
    Google Scholar
  • 10 Losken HW, van Aalst JA, Teotia SS, Dean SB, Hultman S, Uhrich KS. Achieving low cleft palate fistula rates: surgical results and techniques. Cleft Palate Craniofac J 2011; 48 (03) 312-320
    CrossrefPubMedGoogle Scholar
  • 11 Jayarajan R, Natarajan A, Nagamuttu R. Intravelar veloplasty: a review. J Cleft Lip Palate Craniofacial Anomalies 2018; 5 (02) 68-73
    CrossrefGoogle Scholar
  • 12 Kriens OB. An anatomical approach to veloplasty. Plast Reconstr Surg 1969; 43 (01) 29-41
    CrossrefPubMedGoogle Scholar
  • 13 Cutting CB, Rosenbaum J, Rovati L. The technique of muscle repair in the cleft soft palate. Oper Tech Plast Reconstr Surg 1995; 2 (04) 215-222
    CrossrefGoogle Scholar
  • 14 Sommerlad BC. A technique for cleft palate repair. Plast Reconstr Surg 2003; 112 (06) 1542-1548
    CrossrefPubMedGoogle Scholar
  • 15 Bosi V, Brandão G, Yamashita R. Speech resonance and surgical complications after primary palatoplasty with intravelar veloplasty in patients with cleft lip and palate. Rev Bras Cir Plást 2016; 31 (01) 43-52
    Google Scholar
  • 16 Timbang MR, Gharb BB, Rampazzo A, Papay F, Zins J, Doumit G. A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repair. Plast Reconstr Surg 2014; 134 (05) 1014-1022
    CrossrefPubMedGoogle Scholar
  • 17 Zietsman MS, Dibbs RP, Davis MJ, Volk AS, Buchanan EP, Monson LA. Furlow versus straight line repair with intravelar veloplasty: a 7-year single institution experience with fistula formation. FACE 2021; 2 (04) 364-370
    CrossrefGoogle Scholar
  • 18 Gupta R, Kumar S, Murarka AK, Mowar A. Some modifications of the Furlow palatoplasty in wide clefts–a preliminary report. Cleft Palate Craniofac J 2011; 48 (01) 9-19
    CrossrefPubMedGoogle Scholar
  • 19 Nagy K, Swennen G. Oral mucosal Z-plasty in combination with intravelar veloplasty. Plast Reconstr Surg Glob Open 2015; 3 (07) e456
    CrossrefPubMedGoogle Scholar
  • 20 Andrades P, Espinosa-de-Los-Monteros A, Shell IV DH. et al. The importance of radical intravelar veloplasty during two-flap palatoplasty. Plast Reconstr Surg 2008; 122 (04) 1121-1130
    CrossrefPubMedGoogle Scholar
  • 21 Lindman R, Paulin G, Stål PS. Morphological characterization of the levator veli palatini muscle in children born with cleft palates. Cleft Palate Craniofac J 2001; 38 (05) 438-448
    CrossrefPubMedGoogle Scholar