Soft Palate Mucosal Adhesion as a Preparation for Furlow??s Double-Opposing Z-Palatoplasty

Abstract

Furlow's double-opposing Z-palatoplasty enables both soft palate lengthening and palatal muscle reorientation, and outstanding speech results have been reported. However, Z-plasty often results in horizontal stress and requires relaxing incisions in some cases. This article presents the authors' novel two-stage Furlow double-opposing Z-palatoplasty used in 13 cleft lip-cleft palate patients. During cheiloplasty, partial soft palate adhesion was performed. Only mucosal tissue was approximated to prevent damage to the palatal muscle. The residual palatal cleft decreased gradually, and palatoplasty was scheduled at the age of 1 year. Adhesive soft palate tissue was incised and Furlow's double-opposing Z-palatoplasty was performed in the usual manner. Eleven patients underwent Furlow's palatoplasty without relaxing incisions, and in two patients relaxing incisions were required along the inside of the alveolus. Relaxing incisions around the maxillary tuberosities were not required in any of the 13 cases. Analysis of the palatal cast models was carried out on the adhesion group (n = 13) and the control group (n = 9). In both groups, the mean distance between the tuberosities increased, and cleft widths at the alveolus and the middle of the hard palate were decreased. Furthermore, cleft width at the junction of the hard and soft palates was decreased significantly in the adhesion group compared with the control group. As a preparation for Furlow's palatoplasty, soft palate adhesion induced a decrease of cleft width without interfering with the transverse growth of the posterior maxilla and enabled Z-plasty of an adequate size without relaxing incisions.