Cleft palate repair by double opposing Z-plasty

Plastic &amp Reconstructive Surgery (Impact Factor: 3.33). 01/1987; 78(6):724-38. DOI: 10.1016/S1071-0949(06)80036-3
Source: PubMed

ABSTRACT In an attempt to improve speech results following palate repair while allowing adequate maxillary growth, a palatoplasty using two opposing Z-plasties of the soft palate, one of the oral and one of the nasal layers, has been used in 22 infants. Eight patients had unilateral cleft lip and palate, eight had bilateral cleft lip and palate, and six had cleft palate. The Z-plasties facilitate effective dissection and redirection of the palatal muscles to produce an overlapping muscle sling and lengthen the velum without using tissue from the hard palate, which permits hard palate closure without pushback or lateral relaxing incisions. Of the 20 children old enough for speech evaluation, 18 have no velopharyngeal insufficiency. Two have very mild velopharyngeal insufficiency. None has required a pharyngeal flap.

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    • "Selection of this technique for cleft repair at such young age was based on 2 factors, the surgery does not need dissection on the hard palate, and it leaves no raw surface area with no consequent granulation tissue formation as fibrous tissue contracture that may follow palatoplasty may be responsible for retarded maxillary growth [12]. Furlow technique lengthens the soft palate by Z-plasty effect and it reconstructs the levator sling through overlapping both levator palati muscles over each other posteriorly [6] [7]. We achieved normal resonance in 85.7% with residual mild hypernasality in 14.3% of cases who have been benefited from speech therapy. "
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    ABSTRACT: OBJECTIVE: The earlier closure of palatal cleft is the better the speech outcome and the less compensatory articulation errors, however dissection on the hard palate may interfere with facial growth. In Furlow palatoplasty, dissection on the hard palate is not needed and surgery is usually limited to the soft palate, so the technique has no deleterious effect on the facial growth. The aim of this study was to assess the efficacy of Furlow palatoplasty technique on the speech of young infants with cleft soft palate. METHODS: Twenty-one infants with cleft soft palate were included in this study, their ages ranged from 3 to 6 months. Their clefts were repaired using Furlow technique. The patients were followed up for at least 4 years; at the end of the follow up period they were subjected to flexible nasopharyngoscopy to assess the velopharyngeal closure and speech analysis using auditory perceptual assessment. RESULTS: Eighteen cases (85.7%) showed complete velopharyngeal closure, 1 case (4.8%) showed borderline competence, and 2 cases (9.5%) showed borderline incompetence. Normal resonance has been attained in 18 patients (85.7%), and mild hypernasality in 3 patients (14.3%), no patients demonstrated nasal emission of air. Speech therapy was beneficial for cases with residual hypernasality; no cases needed secondary corrective surgery. CONCLUSION: Furlow palatoplasty at a younger age has favorable speech outcome with no detectable morbidity.
    International journal of pediatric otorhinolaryngology 10/2012; 77(1). DOI:10.1016/j.ijporl.2012.09.038 · 1.32 Impact Factor
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    • "A review of the literature revealed a limited description of the arterial anatomy of the soft palate (Cheng et al.). Despite this lack of information, many surgical procedures have been documented for cleft palate repair and for the correction of velopharyngeal insufficiency (Rosenthal, 1924; Rosselli, 1935; Hynes, 1950; Skoog, 1965; Orticochea, 1968; Kriens, 1969; Furlow, 1986). "
    International Journal of Morphology 09/2012; 30(3):847-857. DOI:10.4067/S0717-95022012000300014 · 0.20 Impact Factor
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    • "The rhombic flap (Lister and Gibson, 1972) and double zplasty procedures (Furlow, 1986, 1995) were selected as surgical technical skills to be evaluated (Figs. 2 and 3) based on their innate spatial complexity (Wanzel et al., 2002a,b). Two different procedures were selected in effort to limit the experience bias while still maintaining the comparison between 2D and 3D learning modalities intact. "
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    ABSTRACT: The process of learning new surgical technical skills is vital to the career of a surgeon. The acquisition of these new skills is influenced greatly by visual-spatial ability (VSA) and may be difficult for some learners to rapidly assimilate. In many cases, the role of VSA on the acquisition of a novel technical skill has been explored; however, none have probed the impact of a three-dimensional (3D) video learning module on the acquisition of new surgical skills. The first aim of this study is to capture spatially complex surgical translational flaps using 3D videography and incorporate the footage into a self-contained e-learning module designed in line with the principles of cognitive load theory. The second aim is to assess the efficacy of 3D video as a medium to support the acquisition of complex surgical skills in novice surgeons as evaluated using a global ratings scale. It is hypothesized that the addition of depth in 3D viewing will augment the learner's innate visual spatial abilities, thereby enhancing skill acquisition compared to two-dimensional viewing of the same procedure. Despite growing literature suggesting that 3D correlates directly to enhanced skill acquisition, this study did not differentiate significant results contributing to increased surgical performance. This topic will continue to be explored using more sensitive scales of measurement and more complex "open procedures" capitalizing on the importance of depth perception in surgical manipulation. Anat Sci Educ. © 2012 American Association of Anatomists.
    Anatomical Sciences Education 05/2012; 5(3):138-45. DOI:10.1002/ase.1262 · 2.98 Impact Factor
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