Patients With a History of Oronasal Fistula Repair Exhibit Lower Oral Health Measured With Patient-Centric Outcomes Measures

Abstract

Introduction: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.

An Algorithmic Approach for Deploying Buccal Fat Pad Flaps and Buccal Myomucosal Flaps Strategically in Primary and Secondary Palatoplasty

“…Due to the morbidity of functional palatal fistula formation, one might argue that optimal primary surgery is best to avoid fistula formation. 33 Additionally, BMMF may be reelevated and advanced if needed to close the small postoperative fistula. That being said, these are tools that should be utilized to aid in the reconstruction of more severe phenotypes and to optimize patient outcomes.…”

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

“…The presence of a fistula has been considered as an early indicator of the negative results following primary palatoplasty. 1,[8][9][10]12,13,[22][23][24]26 Different surgical tactics (eg, in-fracture of the hamulus, greater palatine medializing foraminal osteotomy, vascular pedicle skeletonization, raising the mucosa off of the alveolar region, releasing the attached gingiva from the maxillary tuberosity, the elevation of the nasal mucosa off of the medial pterygoid plate in direction to the cranial base and adenoid tissue, degloving of the inferior turbinate, and different types of lateral relaxing incision) have been proposed to release the tension during Z-plasty transposition and midline closure, aiming to reduce fistula formation. [27][28][29][30][31][32] The use of lateral relaxing incision, in particular, has been criticized for the extensive undermining and exposure of raw bone, which potentially increases scarring and impairs transverse maxillary arch development and midfacial growth.…”

Dental caries and periodontitis risk factors in cleft lip and palate patients

“…While fistulas following cleft palate repair may impair hygiene and occur in up to 35 percent of cases ( 21 ). Fritz et al compared the oral health between patients with or without fistula after surgical correction of cleft palate and demonstrated a significantly lower oral health score in the fistula group, indicating poorer oral hygiene ( 22 ). Genes involved in the structure and development of congenital maxillofacial deformity may provide a basis for the link between CLP and dental caries.…”