RESULTS OF CLEFT-PALATE REPAIR WITH THE DOUBLE-REVERSE Z-PLASTY PERFORMED BY RESIDENTS

The double-reverse Z-plasty (Furlow) repair of soft palate clefts has the advantages of lengthening the soft palate while reconstructing the palatal muscle sling to optimize velopharyngeal function. Because sof t tissue from the hard palate Is not mobilized to lengthen the soft pa late, this technique has an additional theoretic advantage of minimizi ng disturbances of maxillofacial growth. Cited disadvantages of the te chnique include increased technical difficulty and operating time comp ared with other procedures. We performed a retrospective study of 20 c onsecutive Furlow repairs of the soft palate performed by residents un der supervision of one attending surgeon between 1989 and 1992. All ch ildren had complete cleft of the soft palate; 14 had incomplete cleft and six had complete cleft of the hard palate, which were repaired by a modified Von Langenbeck technique or with vomer flaps. Mean age of p atients was 15 months, and mean operating time (including placement of pressure-equalizing tubes) was 162 minutes, with an average estimated blood loss of less than 25 ml. Average time until adequate oral intak e was achieved was 1.7 days, and duration of hospitalization averaged 2.4 days. Immediate postoperative complications included transient ton gue edema in one patient and atelectasis and pneumonia in one patient with multiple congenital anomalies. Delayed postoperative complication s included symptoms of sleep apnea in four patients, which subsequentl y improved after tonsillectomy and/or superior adenoidectomy. Fistulas occurred in two patients (10%), which compares favorably with publish ed results of other techniques. Preliminary functional evaluations rev eal that all repairs appear to have adequate length and good mobility; speech evaluations are in progress. Thus the double-reverse Z-plasty technique can be effectively taught to residents, and acceptable compl ication rates and functional results can be achieved.