The relationship between cleft width and oronasal fistula

Amirize, Ezekwe Ekwueme

doi:10.4103/0794-9316.193732

Cited by 6 publications

(5 citation statements)

References 4 publications

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“…It is noteworthy that none of the cases with multiple fistulae resolved by spontaneous closure in the present study. The propensity for dehiscence at the junction of the hard and soft palate has largely been imputed to the facts that palatal cleft is usually widest in this region, as well as mucosa atrophy, inadequacy of muscle bulk and insufficient muscle mobilization for closure at that central area, resulting in greatest tension at closure [13,14], coupled with constant motion of the soft palate as it hinges on the hard palate during velopharyngeal function [15].…”

Section: Discussionmentioning

confidence: 99%

“…CPI calculation entails variables such as Cleft width and palatal tissue deficiency which are more pertinent than mere morpho-anatomical appearance which underpins Veau's classification. Some more recent reports [14,[20][21][22][23][24] are emphasizing on Cleft width as an isolated, singular entity critical to fistula formation after palatal cleft repair. In consonance with this assertion, this present study established significant correlation between Cleft width and ONF occurrence which was marginally superior to that demonstrated by CPI.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of fistula formation after primary palatoplasty

Yarhere,

Akadiri,

Akinbami

et al. 2024

J Oral Med Oral Surg

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Background: The goal of cleft palate repair is to create a seal between the oral and nasal cavities while improving speech by creating a functional velum. Various surgical techniques are at the surgeon's disposal to achieve this. Unfortunately, this sometimes fails, leading to formation of oronasal fistula. Objective: This study aimed to determine the predictors of oronasal fistula (ONF) formation following primary cleft palate repair. Methodology: This prospective interventional study involved cleft palate patients recruited from the University of Port Harcourt Teaching Hospital. Basic demographics and clinical data of participants were recorded preoperatively while morphometric measurements were taken under general anaesthesia to determine Cleft Palate Index and Cleft width. Four surgeons performed the procedures, and three surgical techniques were employed. Participants were followed up for a mean period of 5 months. The occurrence, location, and fate of ONF were documented. Correlation between ONF and potential predictor variables was tested, and determinant(s) of fistula formation was explored. Data was analysed using IBM SPSS version 21.0 with statistical significance set at P < 0.05. Result: Eighty-two participants with ages ranging from 9 months to 19 years completed the study. The initial incidence of ONF was 29.3% but 16.7% of these cases resolved spontaneously within 5 weeks. Cleft Palate Index, Cleft width, and time (age) of repair significantly correlated with occurrence of ONF. However, Cleft width was the only statistically significant (p = 0.049) individual determinant of fistula formation. Conclusion: In this study, Cleft width W is the most important predictor of ONF formation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of fistula formation after primary palatoplasty

Yarhere,

Akadiri,

Akinbami

et al. 2024

J Oral Med Oral Surg

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“…Amaratunga[12] and Lithovius et al [13] also found a correlation between cleft type and fistula occurrence. Amirize[14] found higher fistula rate in Veau Type III clefts than in Veau Type II (11 and 8, respectively). He found a direct correlation between cleft width and risk of oronasal fistula, with high fistula rates in patients with wide cleft >15 mm.…”

Section: Discussionmentioning

confidence: 99%

A statistical analysis of incidence, etiology, and management of palatal fistula

Garg

Shah

Uppal

et al. 2019

Natl J Maxillofac Surg

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Objective: The purpose of this study was to retrospectively review the incidence, profile, and the management of palatal fistula occurring in patients operated for cleft palate in our institute. Materials and Methods: A retrospective analysis was performed on all cleft palatal fistula patients who presented during the period from August 2007 to October 2017, to classify their site, age of presentation, surgery performed, and outcome. A record of the type of cleft palate and previous palatoplasty was also obtained. The outcome in terms of incidence and fistula formation depending on Veau's classification was analyzed. Results: Twenty-two patients reported with palatal fistula during this period. The incidence of fistula formation of our institute was 9.6%. Incisive foramen (13/22) was the most common site of fistula formation. Among various techniques used, local and buccal flaps were found to be useful in a maximum number of cases (14/22). The rate of fistula recurrence was 18.2% (4/22). On retrospective analysis of our institutional data, it was found that the incidence of cleft palate fistula was significantly higher in clefts with Veau Types III and IV (13/18) as compared to Veau Types I and II (5/18). Conclusion: This study shows that the fistula rate of our institution was 9.6%. Complete clefts (unilateral or bilateral) involving both primary and secondary palates predispose more to fistula formation.

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“…Like the findings of [12] in Uganda most of our patients were seen outside the neonatal period. The adult palatal clefts were relatively wider with attendant challenges at Palatoplasty [13]. In addition, cleft teams may need to consider protocols that sustain parents'/patients' interest in the treatment course and/or reduce losses to follow up.…”

Section: Discussionmentioning

confidence: 99%

Challenges to Optimal Care for Orofacial Cleft Patients in Sub-Saharan Africa - The Example of Two Nigerian Tertiary Hospital

Ekwueme.¹

2018

BJSTR

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Background: Complete and comprehensive management of a cleft patient goes beyond surgical repairs. However, certain challenges may limit total rehabilitation. This study intends to highlight specific challenges to optimal care for Orofacial cleft patients in the West African subregion and to suggest possible solution.Methods: This is a cross sectional study carried out at two tertiary hospitals in Nigeria from January 2012 to December 2014. Cleft lip/palate patients were recruited from regular surgical outpatient clinics and during special surgical outreaches organized by the cleft teams of these hospitals. Consent was obtained from all participants (i.e. self or parental consent). In order to execute an inquiry into the challenges to effective care, a comprehensive preformed was drawn to elicit and record patients' and parents' bio-data, relevant history and clinical information as well as patients' perceived treatment needs and desired treatment outcomes. Separate inquiries were made to determine the professional group composition of the multidisciplinary cleft team in each hospital, available cleft care services in each hospital, and the treatment protocols observed by each cleft team. The data gathered were analyzed to determine the challenges to optimal care for the cleft patient.Results: Two-hundred and twenty-eight (228) patients were recruited of whom 57 (25%) were encountered during special surgical outreach programs. Patients' age range was between three weeks and thirty -six years. Observed challenges to optimal care are presented under four considerations namely; "Patient related", "Cleft team related", "Hospital related" and "Outcome related" Considerations. Broadly, the challenges include late presentation, high attrition rate, cleft teams' deficiencies in key specialty services (e.g. orthodontics, and speech therapy), and competing non cleft workload of the cleft team members. Conclusion:Poor awareness, ignorance and financial difficulties accounted mostly for late presentation. Other barriers such as inadequacies of multidisciplinary cleft care services and required facilities in the hospitals were quite limiting. In order to mitigate the challenges, public re-orientation and patient education, infrastructural support, increased funding and training of essential personnel in the full range of skills for cleft care is imperative.

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The relationship between cleft width and oronasal fistula

Cited by 6 publications

References 4 publications

Predictors of fistula formation after primary palatoplasty

Predictors of fistula formation after primary palatoplasty

A statistical analysis of incidence, etiology, and management of palatal fistula

Challenges to Optimal Care for Orofacial Cleft Patients in Sub-Saharan Africa - The Example of Two Nigerian Tertiary Hospital

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