In the 30 years since Leonard Furlow published his landmark article on the double-opposing Z-plasty technique to repair cleft palate, this procedure has been used with great enthusiasm.1 Initially employed in the repair of primary cleft palate, it has been reported in submucous cleft palate and in secondary palate repair with excellent results.2 Studies have shown its success in a variety of measures. These include improvement in speech parameters, including resonance, nasal emission, and plosives.3 The mechanism of its success has been thought to come from a number of factors. First, the Z-plasty both lengthens and strengthens the palate by providing overlapping tissue in a nonlinear fashion to avoid scar contracture. Next, the levator sling mechanism has been essentially repositioned posteriorly, where its function may be improved. Finally, the genu angle has been described to appear to be more acute.3
Kilpatrick LA, Drake AF. Effect of Primary and Revision Repair on Palatal Motion. JAMA Otolaryngol Head Neck Surg. 2017;143(2):116. doi:10.1001/jamaoto.2016.3070
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