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Fistula incidence after primary repair and correlation with cleft width-to-palatum width ratio: A prospective cohort
Rosadi Seswandhana1, Firdian Makrufardi1, Gentur Sudjatmiko2
1Plastic, Reconstructive, and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Insights
Cleft width does not correlate with fistula occurrence after primary palatoplasty. The two-flap, three-layer technique shows promise for low fistula rates in cleft palate repair.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Plastic surgery
Background:
- Cleft lip and palate are common congenital birth defects.
- Fistula rates after primary palatoplasty range from 10-23% within three weeks of surgery.
- Cleft width has been a suspected factor in fistula occurrence.
Purpose of the Study:
- To investigate the correlation between fistula occurrence and cleft width after primary palate repair.
- To analyze the relationship between fistula occurrence and the palate width ratio.
Main Methods:
- A prospective cohort study included 16 subjects (10 males, 6 females).
- Measurements of cleft palate width, remaining palate width, and palate arch width were taken at three levels.
- The two-flap, three-layer suturing technique was employed for primary palate repair.
Main Results:
- Correlation analysis revealed no statistical association between fistula occurrence and cleft width, cleft width-to-remnant palate width ratio, or cleft width-to-palate arch width ratio.
- No significant correlation was found between fistula occurrence and hemoglobin level, white blood cell count, nutritional status, cleft type, or dental caries (p > 0.05).
Conclusions:
- Cleft width is not a determining factor for fistula occurrence post-palatoplasty.
- The two-flap, three-layer technique is a simple method associated with a low rate of fistula occurrence.
Background:
Cleft lip with or without cleft palate is one of the most common birth defects and is certainly the most visible. Fistula rate after primary palatoplasty was ranging between 10 and 23% and could be detected in the first three weeks after surgery. The cleft width is the frequent factor which was assumed to correspond to fistula occurrence. This study aimed to find correlation between fistula occurrence with cleft width and palatum width ratio after primary palate repair.
Methods:
A prospective cohort study was conducted on 16 subjects, which consisted of 10 males and 6 females. We measured width of cleft palate, width of rest palate and width of palate arch on three level measurements (posterior, junction and anterior). The surgery was performed using the two-flap and three layers suturing technique.
Results:
Sixteen patients were enrolled in this study during January and February 2008 . Ten patients were diagnosed with unilateral cleft palate while six patients had bilateral cleft palate. Mean of age was 22.31 ± 5.86 month. Correlation analysis between fistula occurrence and cleft width, cleft width-remnant palate width ratio and cleft width-palate arch width ratio using logistic regression did not show statistical correlation, and the same result was found between fistula occurrence and hemoglobin level, white blood count, nutritional status, cleft type and caries dentis factors (p > 0.05).
Conclusion:
Width of the cleft is not a factor associated with fistula occurrence. Two-flap three layers technique could be considered as a simple technique and gives a low rate of fistula occurrence.
