Speech Outcome of Double Opposing Z-plasty in Contrast to the Wardill-Kilner Procedure

• Published in: Journal of Japanese Cleft Palate Association Vol. 25; no. 3; pp. 277 - 285
• Main Authors: UDAGAWA, Akikazu, KITAGAWA, Yuko, KATO, Masako, NODA, Kojiro, IMATOMI, Setsuko, KIMURA, Tomoe
• Format: Journal Article
• Language: Japanese
• Published: Japanese Cleft Palate Association 31.10.2000
• Subjects: Cleft palate; double opposing Z-plasty; Furlow法; pushback法; speech outcome; Wardill-Kilner procedure; 口蓋裂; 言語成績
• ISSN: 0386-5185; 2186-5701
• DOI: 10.11224/cleftpalate1976.25.3_277

In 1989, Double Opposing Z-plasty was introduced for isolated clefts of the soft palate at Chiba Children's Hospital. Since 1992, it has been used, with our modifications, for all types of clefts. We investigated the velopharyngeal function and articulation of patients, comparing the results obtained by each of double opposing Z-plasty and the Wardrill-Kilner procedure. Subjects were 39 patients undergoing double opposing Z-plasty (Furlow group), and 25 undergoing the Wardill-Kilner procedure (Wardill-Kilner group). All patients were operated on by a single surgeon. Velopharyngeal competence (VPC) and articulation were evaluated by the method of the Committee of Cleft Palate Speech, Japan Association of Logopedics and Phoniatrics. Most of the subjects were from 4 to 5 years of age at the time of evaluation. No systematic speech training was undertaken before evaluation. The results were as follows: 1.82.1% of the Furlow group had sufficient VPC, as compared with 76% of the Wardill-Kilner group. No statistically significant differences were evident between the two groups. When patients were categorized according to the cleft type, no significant statistical difference was found due to cleft type. 2.66.7% of the Furlow group had no articulation errors, while 48.0% of the Wardill-Kilner group had no articulation errors. No statistical difference was evident between the two groups. Among the patients with good VPC,75% of the Furlow group had no articulation errors, as opposed to 47.4% of the Wardill-Kilner group. The Z-plasty group was significantly superior to the Wardill-Kilner group in articulation (χ2=3.986, df=1, p<.05). 3. Among those patients,12.5% of the Furlow group had palatalized articulation, and 3.1%had lateral articulation. On the other hand,26.3% of the Wardill-Kilner group had palatalized articulation, and 31.6% had lateral articulation. Palatalized articulation and lateral articulation were found more frequently in the Wardill-Kilner group. It was assumed that better condition of the maxillary growth of the Furlow group had affected the result of articulation. In conclusion, the two groups revealed no significant difference regarding velopharyngeal competence. In addition, patients in the Furlow group were superior in articulation.