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. 2023 Apr 13;56(2):112-117.
doi: 10.1055/s-0043-1762905. eCollection 2023 Apr.

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

Mukunda Reddy Damalachervu  1 , Rajesh Yellinedi  1 , Rambabu Nuvvula  1 , Dharanipriya A  1
Affiliations

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

Mukunda Reddy Damalachervu et al. Indian J Plast Surg. .

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: Furlow's Z plasty; intravelar veloplasty; palatoplasty.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Schematic diagram showing (left) markings for incision (purple line) and (right) nasal layer ( A ), oral layer ( B ), abnormally inserted palatal muscle ( C ) and markings for anterior (arrowhead) and posterior stabilization (uvuloplasty - arrow mark) before nasal Z plasty.
Fig. 2
Fig. 2
Schematic diagram showing dissected left palatal muscle bundle (arrow mark); stabilized anterior ( A ) and posterior end ( B ) before nasal Z plasty (purple line).
Fig. 3
Fig. 3
Schematic diagram showing transposed anteriorly based nasal Z plasty mucosal flap with few muscle fiber ( A ) and left dissected palatal muscle bundle ( B ) sutured to the transposed posteriorly based mucomuscular nasal Z plasty flap ( C ) for palatal sling reconstruction.
Fig. 4
Fig. 4
Schematic diagram showing markings for small unequal oral Z plasty (green line) with retromolar relaxing incision extending on the molar region (arrow marks).
Fig. 5
Fig. 5
Schematic diagram showing final suture line of the lengthened palate with the transposed small oral Z plasty (arrow head) and raw area of retromolar incisions (arrow marks).
Fig. 6
Fig. 6
Preoperative image showing group II cleft.
Fig. 7
Fig. 7
Intraoperative image showing final suture line with “hybrid palatoplasty.”
See this image and copyright information in PMC

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