Double-Opposing Z-Plasty for Velopharyngeal Insufficiency

BACKGROUND: Furlow's double-opposing Z-plasty (DOZ) can be used to effectively treat velopharyngeal insufficiency (VPI) with minimal complications, but its success rate remains modest. This article presents modifications made to improve DOZ outcomes. METHODS: This retrospective study included 114 patients with marginal VPI who had undergone DOZ performed by a single senior surgeon between 2007 and 2024. Patients with a closure ratio of ≥0.7 on nasopharyngoscopy were selected for this study. The DOZ procedure was modified to maximize soft palate lengthening and include fat grafting. Patients were stratified into 3 groups by the version of the procedure performed: first-, second-, and third-generation techniques. RESULTS: The mean age at surgery was 12.45 ± 7.74 years. Before surgery, the average closure ratio was 0.81. No significant between-group differences were observed in the closure ratio or preoperative velopharyngeal function. The success rates were 80.43%, 88.64%, and 100% for the first-generation (original), second-generation (modified lengthening technique), and third-generation (addition of fat grafting) techniques, respectively. The modified procedure significantly improved velopharyngeal function. No airway obstructions or sleep disturbances were reported. CONCLUSIONS: In the correction of marginal VPI, the modified DOZ procedure incorporating soft palate lengthening and fat grafting may yield optimal outcomes.