Reliability of Oronasal Fistula Classification.

Area of Science:

• Plastic Surgery
• Oral and Maxillofacial Surgery
• Pediatric Surgery

Background:

• Oronasal fistula is a common complication following cleft palate repair.
• Surgical quality assessment often relies on fistula classification.
• Reliability of existing fistula classification systems has not been previously evaluated.

Purpose of the Study:

• To assess the reliability of the Pittsburgh Fistula Classification System.
• To determine intrarater (within-surgeon) reliability for fistula classification.
• To determine interrater (between-surgeon) reliability for fistula classification.

Main Methods:

• Eight experienced cleft surgeons evaluated intraoral photographs of 29 children with repaired cleft palates.
• Surgeons used the Pittsburgh Fistula Classification System to rate fistula location.
• Intraclass correlation coefficients (κ values) were calculated to measure reliability.

Main Results:

• Intrarater reliability for specific fistula regions ranged from moderate to almost perfect (κ = .60-.96).
• Interrater reliability was lower, ranging from fair to substantial (κ = .23-.70), with the lowest reliability at the soft and hard palate junction (κ = .23).
• Both intrarater and interrater reliability were almost perfect for the general classification of secondary palate fistula (κ = .95 and κ = .83, respectively).

Conclusions:

• The Pittsburgh Fistula Classification System demonstrates good reliability when used by a single surgeon.
• Inter-surgeon reliability is lower, indicating potential variability in classification among different surgeons.
• For unbiased comparisons of fistula occurrence, using a general classification of 'presence or absence of fistula in the secondary palate' may be preferable to the detailed Pittsburgh system.