Z-Palatoplasty

The goal of the Z-palatoplasty is to widen the space between the palate and posterior pharyngeal wall, between the palate and tongue base, and either to maintain or even widen the lateral dimensions of the pharynx, goals that are not always achieved with classical uvulopalatopharyngoplasty, where patients may end up with an extremely narrow palatal arch in which the diameter of the oropharyngeal inlet is decreased due to a forward approximation of the posterior palatal mucosa, with a resulting new shape of the free edge of the palate that is triangular, rather than square. Splitting the soft palate and retracting it anterolaterally create an effective anterolateral pull, which actually continues to widen the airway as healing and contracture occur. None of the palatal musculature is resected, despite the aggressive palatal shortening, thereby addressing and minimizing the risk for permanent velopharyngeal insufficiency. This procedure is performed with adjunctive tongue-base reduction procedures, which addresses the hypopharyngeal airway.