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Risk Factors of Fistula Following Primary Palatoplasty
Kaweesak Saothonglang1, Pattama Punyavong, Kengkart Winaikosol
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Insights
Oronasal fistulae (ONF) after primary palatoplasty occurred in 26.07% of patients. Cleft severity, width, and associated syndromes significantly predicted ONF development.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Oronasal fistula (ONF) is a frequent complication following cleft palate repair.
- Understanding ONF prevalence and contributing factors is crucial for improving surgical outcomes.
Purpose of the Study:
- To determine the prevalence of oronasal fistulae (ONF) after primary palatoplasty.
- To identify factors influencing ONF development in patients undergoing primary palatoplasty.
Main Methods:
- A cross-sectional study included 234 patients who underwent primary palatoplasty between 2012 and 2016.
- Data collected included patient demographics, surgeon experience, age at repair, Veau classification, cleft width, and operative technique.
- Prevalence of fistulae was the primary outcome; associations with various factors were secondary outcomes.
Main Results:
- Oronasal fistulae occurred in 61 (26.07%) of the 234 patients.
- Statistically significant associations were found between ONF and Veau classification (OR 2.1), clefts associated with syndromes (OR 4.76), and cleft width > 11.5 mm (OR 1.96).
- No significant association was found with age at repair or surgeon's experience.
Conclusions:
- The prevalence of oronasal fistulae following primary palatoplasty in this cohort was 26.07%.
- Cleft severity (Veau classification), cleft width, and presence of syndromes are significant predictors of postoperative ONF.
- These findings highlight the importance of considering cleft characteristics in surgical planning to minimize ONF risk.
Background:
Oronasal fistula (ONF) is a common complication following cleft palate surgery. This study aims to determine the prevalence of ONF and the factors that influence development of ONF following primary palatoplasty.
Materials And Methods:
There were 234 patients undergoing primary palatoplasty during 2012 to 2016 included in this cross-sectional study. Patient demographics, surgeon's experience, age at the time of primary palatoplasty, cleft type by Veau classification, cleft width, and operative technique were recorded. The prevalence of fistulae was the primary outcome. Association of age at the time of repair, cleft type, cleft associated with syndromes, cleft width, and surgeon's experience with fistula rate were secondary outcomes.
Results:
There were 234 consecutive patients (128 boys [54.7%] and 106 girls [45.3%]). The mean age at primary palatoplasty was 13 months. Oronasal fistulae occurred in 61 (26.07%) patients. There was a statistically significant association between postoperative oronasal fistulae and the following independent variables: Veau classification (adjusted odds ratio 2.1; 95% confidence interval [CI] = 1.45-3.1, P < 0.01), cleft associated with syndromes (adjusted odds ratio 4.76; 95% CI = 1.48-15.2, P < 0.01) and cleft width more than 11.5 mm (adjusted odds ratio 1.96; 95% CI = 1.00-3.85, P = 0.04).
Conclusion:
The overall number of fistulae was moderate in patients who had undergone primary palatoplasty in our center. Cleft severity as defined by the Veau classification, cleft width, and cleft associated with syndromes were predictive factors for development of postoperative fistulae.
