Incidence of fistula after primary cleft palate repair: a 25-year assessment of one surgeon’s experience

Abstract

Background Cleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital.Methods We retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients’ medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test.Results Fistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used.Conclusions The overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

The Life Cycle of Orofacial Cleft Operations

“…30 The staging and techniques used in the primary palatoplasty have been demonstrated to be correlated to incidence of postoperative fistula. 30,31 Some studies have also pointed to an older age at time of primary palate repair to be protective for oronasal fistula. 30 However, others have found no difference in the incidence of post-operative ONF based on age at operation.…”

“…30 However, others have found no difference in the incidence of post-operative ONF based on age at operation. [31][32][33] Nationally, the secondary palatoplasties presumed to be addressing fistulas had an average age of 6.85 ± 4.65 years, which was earlier than those performed for VPI.…”

“…Symptoms of ONF can significantly impact the quality of a child’s life, affecting feeding, speech, and even social acceptability 30 . The staging and techniques used in the primary palatoplasty have been demonstrated to be correlated to incidence of postoperative fistula 30,31 . Some studies have also pointed to an older age at time of primary palate repair to be protective for oronasal fistula 30 .…”

“…Some studies have also pointed to an older age at time of primary palate repair to be protective for oronasal fistula 30 . However, others have found no difference in the incidence of post-operative ONF based on age at operation 31–33 . Nationally, the secondary palatoplasties presumed to be addressing fistulas had an average age of 6.85±4.65 years, which was earlier than those performed for VPI.…”

Role of myringotomy in patient with cleft palate

“…type of study Park MS et al, 8 retrospective Sumun K et al, 9 retrospective Jung SE et al, 10 retrospective Mantilla-Rivas et al, 11 retrospective Shaffer AD et al, 12 retrospective Yang CH et al, 13 retrospective Bruneel L et al, 14 retrospective Imbery TE et al, 15 retrospective Kim E et al, 16 retrospective Ha S et al, 17 retrospective Annigeri VM et al, 18 retopective Kobayashi H et al, 5 retopective 16 , as they reported that after adjustment for potential confounders with multivariate analysis, patients who received four or more sets of VTs, those with a history of TM perforation, and those with isolated cleft palate were found to be at an increased risk for hearing loss at 10-year follow-up. Age of first tube placement and total number of otologic complications were not independent predictors of hearing loss on adjusted analysis.…”