Palatal fistulae: a comprehensive classification and difficulty index.

Area of Science:

• Cleft lip and palate surgery
• Oral and maxillofacial surgery
• Plastic surgery

Background:

• Palatal fistula is a common complication following palatoplasty.
• Existing classifications do not assess surgical difficulty.
• Effective management of palatal fistulae is challenging.

Purpose of the Study:

• To devise a novel classification system for palatal fistulae.
• To develop a difficulty index for palatal fistulae.
• To aid in surgical planning and prognosis prediction.

Main Methods:

• Reviewed 610 cases of palatal fistula operated between May 2003 and May 2010.
• Applied a newly devised classification system and difficulty index.
• Analyzed recurrence rates based on fistula type and cleft laterality.

Main Results:

• Longitudinal fistulae had a 7.87% recurrence rate; transverse fistulae had a 19.66% recurrence rate.
• Fistulae in bilateral clefts (14.17%) recurred more often than in unilateral clefts (6.55%).
• Grade 2 fistulae showed a higher recurrence rate (15.90%) compared to Grade 1 (3.18%).

Conclusions:

• A classification system and difficulty index are crucial for effective palatal fistula surgical planning.
• Bidimensional fistulae in the anterior hard palate and fistulae in bilateral clefts are associated with higher recurrence.
• The difficulty index assists in pre-operative judgment of surgical outcomes for palatal fistulae.