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Time Trends and Determinants of Fistula in Cleft Patients at BC Children's Hospital, Canada: A Retrospective 18-Year
Insights
Palatal fistula rates in children with clefts were 28%, influenced by cleft type and surgical factors. Incidence decreased after 2009, highlighting improvements in treatment for cleft lip and palate care.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Plastic Surgery
Background:
- Palatal fistula is a common complication following cleft palate repair.
- Understanding its incidence and contributing factors is crucial for improving surgical outcomes.
Purpose of the Study:
- To analyze time trends and identify determinants of palatal fistula in children with various cleft types.
- To evaluate the impact of cleft severity, treatment period, surgical technique, and surgeon experience on fistula occurrence.
Main Methods:
- Retrospective chart review of 558 nonsyndromic patients with cleft lip and palate treated between 1995 and 2012.
- Assessment of primary palatal fistula occurrence and analysis of factors including cleft type (unilateral cleft lip and palate, bilateral cleft lip and palate, isolated cleft palate), surgery type, and surgeon experience.
Main Results:
- The overall postoperative palatal fistula rate was 28%.
- Higher fistula rates were observed in patients with bilateral cleft lip and palate, earlier treatment periods, two-flap palatoplasty, and less experienced surgeons.
- Fistula incidence declined after 2009.
Conclusions:
- Palatal fistula rates are significantly influenced by cleft severity, treatment timing, surgical approach, and surgeon expertise.
- The observed decline in fistula rates suggests improvements in surgical techniques or management over time.
- Further research into optimizing surgical strategies for cleft palate repair is warranted.
Objective:
To examine the time trends and determinants of palatal fistula in children with different types of cleft at British Columbia's Children's Hospital between 1995 and 2012.
Methods:
A total of 558 medical charts of nonsyndromic patients with cleft lip and palate were eligible for the chart review. The occurrence of primary palatal fistula was assessed at any time throughout the patient's total observation period. Three types of clefts were recorded: unilateral cleft lip and palate (ULCLP), bilateral cleft lip and palate (BLCLP), and isolated cleft palate (ICP). Cleft severity, time period of treatment, type of surgery and surgeon's experience were tested as determinants.
Results:
Of all 558 patients, 228 had ULCLP, 226 had ICP, and 104 had BLCLP. The combined postoperative palatal fistula rate was 28%. The significant differences in fistula rates related to type of cleft (patients with BLCLP had the highest fistula rates), time period (rates were higher in earlier years than in later years), type of surgery (highest rates were for two-flap palatoplasty), and surgeons with less experience.
Conclusions:
Almost one quarter of the patients, developed fistula, and fistula incidence declined after 2009. The higher fistula rates were determined by cleft severity, time period of treatment, type of surgery, and surgeon's experience.
