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Published on: September 19, 2015
Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair
A R Muzaffar1, H S Byrd, R J Rohrich
1Department of Plastic Surgery, University of Texas Southwestern Medical Center/Children's Medical Center, Dallas, Texas 75235-9132, USA.
Insights
The incidence of cleft palatal fistula in nonsyndromic children was 8.7%, with higher rates in severe clefts (Veau 3 and 4). Recurrence was 33%, primarily in the anterior palate.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Plastic Surgery
Background:
- Cleft palate repair aims to restore function and aesthetics.
- Fistula formation is a potential complication following palatoplasty.
- Understanding risk factors for cleft palate fistula is crucial for improving surgical outcomes.
Purpose of the Study:
- To determine the incidence of cleft palatal fistula in nonsyndromic children.
- To analyze the relationship between fistula occurrence and cleft severity (Veau classification).
- To identify factors associated with fistula recurrence after primary palatoplasty.
Main Methods:
- Retrospective analysis of 103 nonsyndromic cleft palate patients treated between 1982 and 1995.
- Data collected included patient demographics, cleft classification, surgical details, and follow-up.
- Statistical analysis involved contingency tables, logistic regression, and Wilcoxon rank sum test.
Main Results:
- The overall incidence of clinically significant cleft palatal fistula was 8.7%.
- Fistula incidence was significantly higher in patients with Veau 3 and 4 clefts compared to Veau 1 and 2 clefts (p=0.0441).
- The recurrence rate for fistulas was 33%, with all recurrent fistulas located in the anterior palate.
Conclusions:
- Cleft severity, specifically Veau class 3 and 4, is a significant risk factor for palatal fistula formation.
- Early delayed primary closure may contribute to a lower rate of clinically significant fistulas.
- Further research into optimizing surgical techniques for severe clefts is warranted to minimize fistula complications.
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.
