Long-term outcome analysis of two treatment methods for cleft palate: Combined levator retropositioning and pharyngeal flap versus double-opposing Z-plasty

Objective: Two surgical techniques for repair of a cleft palate include lev ator retropositioning in combination with a pharyngeal flap and the Furlow double-opposing Z-plasty. This study compared morbidity and speech results from the use of these two methods in an effort to determine which was the s uperior technique. Design: Patient records from 1986 to 1996 were retrospectively reviewed, an d 10 patients with a cleft palate who underwent repair with a levator retro positioning and pharyngeal flap were compared to 14 patients who underwent a double-opposing Z-plasty repair, Postoperative complications including fi stula formation, obstructive sleep apnea, and residual velopharyngeal insuf ficiency were recorded. Speech was assessed perceptually and through the us e of nasometry. Results: Both surgical techniques resulted in good speech in the majority o f patients. Only two patients in the study, both in the Z-plasty group, had severe postoperative hypernasality, Two patients in the levator retroposit ioning and pharyngeal flap group developed severe postoperative obstructive sleep apnea, requiring additional surgery. Conclusion: The levator retropositioning and pharyngeal flap technique was successful in achieving good speech results, but it also caused more seriou s postoperative complications when compared to the double-opposing Z-plasty technique.