Fistula Rate after primary palatal repair with intravelarveloplasty: a retrospective three-year audit of six units (NorCleft) in the UK

Moar, Kanwalraj; Sweet, Christopher; Beale, Victoria

doi:10.1016/j.bjoms.2016.03.021

Cited by 23 publications

(26 citation statements)

References 9 publications

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“…Fistula rate. This study had a relatively similar fistula rate of 10.7% compared to 14% in the study by Moar et al (2016). Moar et al (2016) reported that those requiring lateral releasing incisions were significantly more likely to have a fistula, which was also found in this study.…”

Section: Comparison With Other "Sommerlad Technique" Studiessupporting

confidence: 82%

“…This study had a relatively similar fistula rate of 10.7% compared to 14% in the study by Moar et al (2016). Moar et al (2016) reported that those requiring lateral releasing incisions were significantly more likely to have a fistula, which was also found in this study. In contrast, Becker & Hansson (2013) concluded that their low fistula rate (5%) after using the Sommerlad technique was due to their liberal use of lateral releasing incisions (42% of their cohort), considerably higher than in this study.…”

Section: Comparison With Other "Sommerlad Technique" Studiessupporting

confidence: 82%

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Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique

Baillie

Sell

2020

The Cleft Palate Craniofacial Journal

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Objective: To report speech and velopharyngeal function (VPF) outcomes, and surgical characteristics, at age 5 following early complete palate closure using the Sommerlad protocol. Design: A retrospective, descriptive, cross-sectional consecutive series. Setting: A regional twin site center; a district general hospital and tertiary children’s hospital. Participants: Between 1993 and 2006, 877 participants underwent surgery; 712 (81%) were eligible for inclusion; 391 (55%) were included, 321 (45%) excluded. Thirteen percent had bilateral cleft lip and palate (CLP), 40% unilateral CLP, and 47% isolated cleft palate. Intervention: Lip and vomerine flap repair at 3 months of age (BCLP, UCLP) with soft palate closure using radical muscle dissection and retropositioning at a mean age of 6.6 months, range 4 to 23 months, as described and undertaken by Sommerlad. Outcome Measures: Velopharyngeal Composite (VPC) CAPS-A and articulation summary scores derived from analysis using the Cleft Audit Protocol for Speech-Augmented. Results: A VPC-SUM CAPS-A score of “0” was found in 97% reflecting adequate VPF; 73% had no cleft articulation difficulties. The BCLP group had the poorest articulation. Secondary speech surgery rate was 2.6% and 10.7% had fistula repair. Levator muscle quality and degree of retropositioning was associated with speech outcomes related to VPF. 2.6% had current features of VPI. Conclusions: Complete palate closure by around 6 months of age by the surgeon who described the technique led to excellent perceived VPF and very good speech outcomes at age 5, with less speech therapy and secondary speech surgery than commonly reported. These findings serve as a benchmark for the Sommerlad protocol and technique.

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Section: Comparison With Other "Sommerlad Technique" Studiessupporting

confidence: 82%

Section: Comparison With Other "Sommerlad Technique" Studiessupporting

confidence: 82%

Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique

Baillie

Sell

2020

The Cleft Palate Craniofacial Journal

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“…Sommerlad in his UK personal series of UCLP cases reported only symptomatic fistulas repaired in 14% (11 of 80) children following Oslo staging and radical intravelar veloplasty (Sommerlad, 2003). A retrospective UCLP case note review by 6 northern UK cleft units (NorCleft) reported postincisive fistula prevalence at age 3 to be 11% (Moar et al, 2016). Although the results from these 2 studies cannot be extrapolated to a national average, both of their estimates were far lower than the finding by the present study.…”

Section: Discussioncontrasting

confidence: 61%

Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study

Yang

Richard

Wills

et al. 2019

The Cleft Palate Craniofacial Journal

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Objectives: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Design: Cross-sectional study. Setting: All 11 centralized regional cleft centers in the United Kingdom. Participants: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Main Outcome Measure: Nonperialveolar palatal fistula prevalence up to age 5. Results: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. Conclusion: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

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“…In a similar example of the lack of large-scale bilateral CLP data, systematic reviews of unintended palatal fistulae for all cleft phenotypes puts the average fistula rate at between 4.9% and 8.6%. 28 , 29 However, the small reviews available for bilateral palatal clefts (19–63 patients) suggest the fistula rate increases to 20–79% 20 , 30 – 32 in this phenotype, substantially higher than the 6.7% fistula rate found in this study. The variability in these results is likely influenced by the small patient numbers included in each of these series, including our own.…”

Section: Discussioncontrasting

confidence: 76%

Collection of Bilateral Cleft Lip and Palate Standard Set Variables: Establishing a Baseline

Citron

Ganske

Massenburg

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:The International Consortium for Healthcare Outcomes Measurement recently published a consensus Standard Set of clinical and patient-centered metrics to measure outcomes for patients with cleft lip and/or palate (CLP). This study aims to evaluate how the Standard Set compares to existing data collected to anticipate the impact that the Standard Set may have on quality and quantity of outcome data.Methods:Extraction of the Standard Set data points was attempted retrospectively for all nonsyndromic patients with bilateral cleft lip and/or palate who underwent primary lip and/or palate repair by a single surgeon (JGM) between June 2007 and June 2014.Results:Bilateral cleft lip repair was performed on 32 patients of which 29 also underwent palate repair. All but one of the baseline demographic and phenotypic variables were available. All perioperative variables were collected, but data quality was heterogeneous. There were no early complications. At 5 years, 29.6% of patients were lost to follow-up; however, a degree of data was available on 11 of the 12 clinical metrics for those remaining. Of patients with Veau IV cleft palate and follow-up at age 5, 1 patient (6.7%) had an oronasal fistula and 1 had velopharyngeal incompetence requiring Furlow palatoplasty (6.7%). No patient-reported data were collected for any time point.Conclusion:Prospective collection of the International Consortium for Healthcare Outcomes Measurement Standard Set will improve consistency of clinical data and add the patient perspective currently lacking in outcome measures collected for patients with bilateral cleft.

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Fistula Rate after primary palatal repair with intravelarveloplasty: a retrospective three-year audit of six units (NorCleft) in the UK

Cited by 23 publications

References 9 publications

Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique

Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique

Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study

Collection of Bilateral Cleft Lip and Palate Standard Set Variables: Establishing a Baseline

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