Incidence of Cleft Palate Fistula: An Institutional Experience with Two-Stage Palatal Repair

Abstract

The purpose of this study was to determine the incidence of cleft palatal fistula in a series of nonsyndromic children treated at the authors' institution. This retrospective analysis of 103 patients with cleft palate treated by five surgeons between 1982 and 1995 includes 60 boys and 33 girls, whose median age was 18.4 months at the time of surgery. The median length of follow-up was 4.9 years after primary palatoplasty. Cleft palatal fistula was defined as a failure of healing or a breakdown in the primary surgical repair of the palate. Intentionally unrepaired fistulas of the primary and secondary palate were excluded. Extent of clefting was described according to the Veau classification. Statistical examination of multiple variables was performed using contingency table analysis, multivariate logistic regression, and the Wilcoxon rank sum test. The incidence of cleft palatal fistula in this series was 8.7 percent. All of these fistulas were clinically significant. The rate of fistula recurrence was 33 percent. The incidence of cleft palatal fistula when compared by Veau classification was statistically significant, with nine fistulas occurring in patients with Veau 3 and 4 clefts and no fistulas occurring in patients with Veau 1 and 2 clefts (p = 0.0441). No significant differences between patients with and without fistulas were identified with respect to operating surgeon, patient sex, patient age at palatoplasty, type of palatoplasty, and use of presurgical orthopedics or palatal expansion. All three recurrent fistulas occurred in the anterior palate, two in patients with Veau class 3 clefts and one in a patient with a Veau class 4 cleft. The low rate of clinically significant fistula was attributed to early delayed primary closure, with smaller secondary clefts allowing repair with a minimum of dissection and disruption of vascularity.

Cleft Lip and Palate; Prevalence, Patients Presenting to a Surgical Ward at Allied Hospital Faisalabad, in One Year

“…Out of total 55 patients in this group 12 patients (21.81 % while internationally it is 36.44%) were included. 21 7 patients (58.33%) were males and 5 patients (41.66%) were females while international this ratio is 1, 21 almost same as in our study. 10 patients (83.33%) have incomplete and 2 patients (16.77%) had complete palatal defect, if we compare this with international figures it is 57% and 43%.…”

“…3 patients (14.2 %) parents were cousins. Out of these 32 patients 21 patients ( 65.62 % ) had left sided cleft lip, 4 patients (12.5 %), had right sided the sum of total 78.12% and 7 patients (21.87 % ) had bilateral cleft lips, while international it exists as 79% and 20% 21,22 respectively. All mothers were non-smokers, no radiation and drug intake history during gestation, all fathers were smokers and all patients belongs to poor socio-economic group, living in low lying areas, utilizing impure water supplies in old lead pipes and adopting poor standards of life.…”

Palatal Fistula Post-Cleft Palate Repair: A Tertiary Center Experience in Oman

“…They reported no significant difference between the two groups in regard to gender, age at palatoplasty and type of palate repair [20].…”

Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

“…Th e relatively small samples of each type of cleft and also a variety of technical surgery used in either of the two protocols represent limits of this study. In the literature, for the cleft type, some authors consider fi stula incidence is proportional with the severity of the malformation [14,15], while others don't [7]. Better than the cleft type seems to be, for fi stula prediction, the width of the cleft palate [7,16].…”