PURPOSE:
The double-opposing Z-plasty palatal repair, as reported by Dr Furlow, is one of the most popular methods of primary cleft palate repair. However, the repair as originally described is often difficult to perform, especially on wide palatal clefts. The purpose of this study is to evaluate the results of our modification of the original technique with respect to fistula rates and long term outcome.
METHODS:
We performed a retrospective review of children undergoing double-opposing Z-plasty cleft palate repairs with or without islandization of the hemi-palate on its vascular pedicle over a ten-year period at the Childrens Hospital Los Angeles. Children were evaluated based on their age at time of repair, extent of cleft, and occurrence of postoperative fistulae, occurrence of velopharyngeal incompetence (vpi) requiring surgical treatment and need for maxillofacial surgery to correct midface hypoplasia.
RESULTS:
Over seven hundred children underwent cleft palate repair during this time period and 168 children did not have hemi-palatal islandization. The overall fistula rate in this series was 5.0%. When the experience of the five pediatric plastic surgeons in this series were combined, patients undergoing pedicle lengthening had significantly lower fistula rates (2.1%) than patients undergoing palatoplasty without pedicle lengthening (10.6%). Patient gender, age, and extent of clefting did not correlate with the rate of fistula formation in this study. There was no statistical difference between the number of patients requiring surgery for velopharyngeal incompetence (VPI) between the two groups, 10.6% in the islandized group vs. 11.6% in the non-islandized group. There was also no statistical difference between the groups in the requirement for maxillofacial surgery, 4.2% in the islandized group vs. 4.7% in the non-islandized group.
CONCLUSION:
Our data suggests that a double-opposing Z-plasty palate repair performed with islandization results in lower postoperative fistula rates when compared to repair done without islandization without increasing the incidence of VPI or adversely affecting maxillary growth.