Difficulty Index-Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience

In the present study, we have highlighted the occurrence of different palatal fistulas and evaluated the difficulty level in planning the treatment, thereby enabling the prediction of the prognosis preoperatively.

The present retrospective study included 62 nonsyndromic cases with primary surgery and palatal fistula repair performed in our unit. Data were collected on the fistula incidence, site, and size, cleft type, fistula closure method. All these were categorized, analyzed, and scored according to the difficulty index reported by Richardson et al. The data were statistically analyzed using χ² analysis and Fisher's exact test.

The incidence of palatal fistula was 4.58%, with the transverse type (74%) the predominant type. The difficulty index was grade 1 and 2 for 33 (53.2%) and 29 (46.8%) patients, respectively. The recurrence rate was 35.4%, with 6.4 and 28.9% observed in the grade 1 and grade 2 groups, respectively (P = .019). The surgical techniques included tongue flap, redo palatoplasty, rotation flap, and a combination of rotation with a buccal fat pad. The incidence of recurrence was dependent on the type of surgical management and the difficulty index score (P = .047).

Palatal fistula closure is a technically difficult procedure with a high recurrence rate. Thus, the difficulty level index for closure must be evaluated to predict the outcomes of the procedure before surgery. Also, further studies are required to introduce a standardized classification system of fistula complexity to address the difficulty in their management.