Achieving Low Cleft Palate Fistula Rates: Surgical Results and Techniques

Abstract

This study summarizes one of the lowest overall fistula rates reported in the literature. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a very low fistula rate. Technical keys to achieving low fistula rate include skeletonization of the vascular pedicle for medialization of the mucoperiosteal flaps, aggressive posterior repositioning of the levator muscle, and meticulous two-layer mattress-suture closure. We recommend Furlow repair for narrower clefts (less than 8 mm wide at the posterior border of the hard palate) and the Bardach two-flap palatoplasty for wider clefts.

Effects of Cleft Width and Veau Type on Incidence of Palatal Fistula and Velopharyngeal Insufficiency After Cleft Palate Repair

“…4,7 Most of our patients underwent a 2-flap palatoplasty, which has previously yielded similarly low fistula rates. 2,10,19 Contrasting with previous reports, 7,12 in this study, there was no association between cleft width and fistula formation after controlling for Veau type. Lack of an association may have partially been due to the overall low fistula rates.…”

Analysis of Complications in Primary Cleft Lips and Palates Surgery

“…Overall, the low incidence has been achieved and this can be explained by the collaboration of a highly specialized team. 25 However, complications still are unavoidable clinically and often lead to serious prognosis. In this study, the whole incidence of complications was relatively higher; however, the serious cases were on the contrary.…”

Closure of palatal fistulae

“…Losken et al initially noted a 35.8% overall fistula rate with the highest rates when a Furlow repair was performed followed by a von Langenbeck, then Bardach two-flap technique. 7 Rates were higher in Veau IV patients. The authors subsequently limited the Furlow repair to narrow clefts and used a Bardach two-flap technique for wide clefts with a focus on tension-free closure, aggressive mobilization of the pedicles, and an intravelar veloplasty.…”