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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    ABSTRACT: We treated a patient with cleft lip and palate by palatoplasty, and he subsequently developed sleep apnea. We then performed tonsillectomy, to improve the sleep apnea, and were able to do this successfully without impairing velopharyngeal function. This successful result was achieved by collaboration between the oral and maxillofacial surgeons who initially performed the palatoplasty and the otolaryngologists who treated the patient for sleep apnea. The decision to remove the palatine tonsils was based on careful observation of the respiratory and sleeping conditions of the patient during sleep, together with polysomnography (PSG). The tonsillectomy was done using a two-step procedure. We obtained a good treatment outcome in a patient with cleft lip and palate who had sleep apnea, based on collaboration between otolaryngologists and oral and maxillofacial surgeons.
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    ABSTRACT: The levator veli palatini (LVP) muscle has long been recognized as the muscle that contributes most to velopharyngeal (VP) closure and is therefore of principal importance for restoring normal speech in patients with a cleft palate. Different surgical reconstructive procedures can utilize varying degrees of LVP overlap, and this study developed a new finite-element model of VP closure designed to understand the biomechanical effects of LVP overlap. A three-dimensional (3D) finite element model was created from adult anatomical dimensions and parameters taken from the literature. Velopharyngeal function was simulated and compared with experimental measurements of velopharyngeal closure force from a previous study. Varying degrees of overlap and separation of the levator veli palatini were simulated and the corresponding closure force was calculated. The computational model compares favorably with the experimental measurements of closure force from the literature. Furthermore, the model predicts that there is an optimal level of overlap that maximizes the potential for the LVP to generate closure force. The model predicts that achieving optimal overlap can increase closure force up to roughly 100% when compared with too little or too much overlap. The results of using this new model of VP closure suggest that optimizing LVP overlap may produce improved surgical outcomes due to the intrinsic properties of muscle. Future work will compare these model predictions with clinical observations and provide further insights into optimal cleft palate repair and other craniofacial surgeries.
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