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Re-evaluating fistula management in cleft palate: longitudinal changes and risk determinants after double-opposing
1Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
International Journal of Oral and Maxillofacial Surgery
|October 15, 2024
Summary
Cleft width, not Veau classification, predicts palatal fistula (PF) after double-opposing Z-plasty (DOZ). Most PFs resolve spontaneously, suggesting a conservative approach for smaller fistulas.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Palatal fistula (PF) is a potential complication following cleft palate (CP) repair.
- Double-opposing Z-plasty (DOZ) is a common surgical technique for CP closure.
Purpose of the Study:
- To identify risk factors for palatal fistula formation after DOZ.
- To evaluate the outcomes of surgical repair versus conservative management of PFs.
Main Methods:
- Longitudinal follow-up of 1557 patients undergoing DOZ.
- Analysis of PF incidence, characteristics, and healing patterns.
- Multivariate logistic regression to determine predictors of PF development.
Main Results:
- Overall PF incidence was 6.7%, with higher rates in Veau class 4 clefts.
- Cleft width was the most significant predictor of PF development (OR 1.25, P < 0.001).
- 75.6% of unrepaired PFs resolved spontaneously, with recovery varying by fistula size.
Conclusions:
- Cleft width is a critical determinant of PF risk after DOZ.
- A conservative management strategy prioritizing symptomatology over size for small PFs (<1 cm²) may be appropriate.
- Spontaneous resolution is common for PFs, particularly smaller ones.
