Single Oral Z-plasty: A Clinical Validation of a Technique for Palatal Lengthening in Primary and Secondary Cleft Palate Repair.

PURPOSE: In cleft palate repair, palate length is associated with improved speech outcomes. While direct closure offers poor palatal lengthening, utilization of two opposing Z-plasties may reorient palatal musculature and lengthen the velum. We previously described a novel overlapping intravelar veloplasty to achieve longitudinal closure of the nasal mucosa with a single oral Z-plasty (1ZP), lengthening the palate in cadaver studies. This study aims to corroborate this finding in clinical cases.

METHODS: A retrospective comparative study of patients with a cleft palate was conducted. Patients underwent cleft palate closure with 1ZP or IVV with straight line closure. Pre- and post-operative measurements of the palate along four dimensions were recorded. Analysis was conducted on pre-and-post operative measurements within and between groups using the Mann-Whitney-Wilcoxon or Chi Squared test.

RESULTS: 85 patients were included (1ZP=65, Straight line closure = 20). 1ZP increased soft palate length (SPL) by 33% (p<0.001) and total palate length (TPL) by 10% (p<0.001). Primary 1ZP increased SPL by 33% (p<0.001) and TPL by 10% (p<0.001). Secondary 1ZP increased SPL by 28% (p<0.001) and TPL by 8% (p<0.001). When comparing between primary and secondary 1ZP, 1ZP was equal percent lengthening in SPL(p > 0.9) and TPL (p > 0.3). When compared to straight line closure, 1ZP showed superior percent lengthening in SPL (p<0.001), and TPL (p=0.038).

CONCLUSION: 1ZP results in a statistically significant increase in palate length in both primary and secondary cleft palate repair. This technique provides an effective alternative in patients for whom 2ZP is not feasible.