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

Balushi, Abdullah Al; Sahib, Mohudoom Meera; Balushi, Taimoor Al

doi:10.4236/mps.2017.73003

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Palatal fistulas as a sequela of infection after cleft surgery can present anytime between one and 78 months (mean, ~9 months) after surgery [ 27 ]. Our search revealed some, though limited, data supporting the use of postoperative antibiotics to prevent fistula development.…”

Section: Reviewmentioning

confidence: 99%

Prophylactic Antibiotics After Cleft Lip and Palate Reconstruction: A Review From a Global Health Perspective

Piccillo¹,

Farsar²,

Holmes³

2023

Cureus

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Orofacial clefts are common congenital deformities. Global initiatives have increased access to cleft care and reconstruction surgeries for cleft lip with or without cleft palate (CL/P), but there is no consensus on the use of postoperative prophylactic antibiotics. We conducted a narrative review using PubMed on the use of postoperative prophylactic antibiotics in CL/P surgery. A search of PubMed identified 30 potentially relevant articles, of which 15 were reviewed. There was no consensus among surgeons on prescribing patterns, but there was limited evidence that postoperative antibiotics reduce palatal fistulas. Notably, microbiological screening is not used to guide the choice of antimicrobial or to predict postoperative complications. Based on limited available data, we cannot make any strong evidence-based recommendations on prescribing postoperative antibiotics; however, we recommend that each cleft surgeon performing these procedures in lower-income countries without access to tertiary care centers consider the cost-benefit analysis of prescribing antimicrobials postoperatively, without antimicrobial screening, which showed no benefit.

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Section: Reviewmentioning

confidence: 99%

Prophylactic Antibiotics After Cleft Lip and Palate Reconstruction: A Review From a Global Health Perspective

Piccillo¹,

Farsar²,

Holmes³

2023

Cureus

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The effect of collagen matrix graft on palatal fistula formation after cleft palate repair: A preliminary randomized controlled study

Egbunah,

Zhu,

Hauri

et al. 2024

Journal of Cleft Lip Palate and Craniofacial Anomalies

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Objective: The objective of this study was to compare the incidence of palatal fistula formation between cleft palate (CP) repair with collagen matrix graft and conventional repair without collagen matrix graft. Patients and Methods: This was a preliminary randomized controlled study of patients with CP who underwent primary palatoplasty (two-flap palatoplasty technique) at the Lagos University Teaching Hospital. Patients were randomly allocated to either the test group (palatoplasty with collagen graft) or the control group (palatoplasty without collagen graft). The primary outcome was palatal fistula, and secondary outcomes were wound dehiscence, surgical site inflammation, surgical site infection, and surgeon satisfaction up to 3 months postoperative (PO). Results: Ten patients were recruited, five in each group. Only one patient in the control group developed a palatal fistula at 1 month PO on the soft palate which extended to the junction of hard and soft palate at 3 months PO. Eight patients developed wound dehiscence, five in the test group and three in the control group. Surgical site inflammation persisted up to at least 7 days PO in nine patients (five in the test group and four in the control group). All persistent wound dehiscence and surgical site inflammation resolved at 3 months PO. No patient developed surgical site infection. No significant difference was seen between the study group and wound dehiscence, surgery time, and difficulty of the procedure (P > 0.05 for all associations). Conclusion: Collagen graft may have a protective effect against fistula formation without significantly increasing surgery time and difficulty. However, due to the small sample size, the study failed to draw definite conclusions. Results from this study may inform future designs of larger randomized controlled studies.

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Evaluation of using collagen membrane as interpositional material in closure of palatal fistula in cleft patients

Selim,

Khalifa,

Ibrahim

et al. 2023

Tanta Dental Journal

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Background Palatal fistula after palatal surgery in cleft patients is an annoying problem for both patients and maxillofacial surgeons. The occurrence of fistula is determined by the severity of the underlying defect, the repair technique utilized and the stress applied to the wound. Fistula recurrence rates range from 0% to 58%. Depending on the size, recurrence rate, and surgeon skill, various procedures for palatal fistula closure are documented, ranging from local mucoperiosteal flaps to free flaps. Colla-D is a pure collagen membrane developed to facilitate directed tissue regeneration and aid in the closure of palatal fistulas. Patients and methods A prospective randomized noncontrolled clinical research was conducted on 12 patients with palatal fistulas in the hard palate of cleft patients aged 6 to 20 years. Collagen membrane (Colla-D type BS) is utilized as an interposition material between the oral and nasal layers in cleft patients to aid in the closure of palatal fistulas. Results Collagen membrane was integrated with successful fistula closure in nine (75%) individuals, but palatal closure failure was detected early postoperatively in three (25%) patients. In seven patients, the oral mucosal layer dehisced, exposing the membrane, which was gradually covered by creeping oral mucosa in 4 of 7 patients over a period of 2 to 4 weeks postoperatively. All patients improved in nasalance and even failed cases improved slightly due to a decrease in fistula size, with a mean progress of 33.92% and a standard deviation of 7.28. Conclusions Colla-D collagen membrane is a safe and effective adjunct for the closure of palatal fistulas located in hard palate.

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

Cited by 3 publications

References 21 publications

Prophylactic Antibiotics After Cleft Lip and Palate Reconstruction: A Review From a Global Health Perspective

Prophylactic Antibiotics After Cleft Lip and Palate Reconstruction: A Review From a Global Health Perspective

The effect of collagen matrix graft on palatal fistula formation after cleft palate repair: A preliminary randomized controlled study

Evaluation of using collagen membrane as interpositional material in closure of palatal fistula in cleft patients

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