Appropriate Characteristics for Cleft Palate Surgery by Chief Residency in Plastic Surgery Training Programs

Cleft palate repair is a challenge for residency training programs due to the small cavity, limited access, and delicate tissue handling, which can lead to complications such as oronasal fistula (ONF) in inexperienced surgeons. Practical hands-on experience is essential for training programs.

The retrospective study included 186 patients who underwent primary palatoplasty between January 2012 and December 2021. Chief residents performed the procedures under the supervision of surgeons. The analysis aimed to determine the suitable criteria for conducting cleft palate surgery, focusing on the chief residency of a plastic surgery training program.

In all cases in this series, using the 2-flap palatoplasty technique resulted in an observed postoperative ONF rate of 22.04%. The study demonstrated that a cleft width exceeding 11.5 mm increased the likelihood of ONF by 5.23 times (P = 0.001). Furthermore, the implementation of preoperative nasoalveolar molding and buccal fat flaps was associated with a reduced risk of ONF (odds ratios = 0.34, 0.06, P = 0.035, 0.006). Notably, variables such as age at surgery, sex, Veau type, and the side of the cleft palate were nonsignificant predictors of ONF following palatoplasty.

Procedural practice on actual patients remains vital for training competent plastic surgeons. However, we must strike a balance between the surgical benefits and postoperative risks. Appropriate case selection is crucial, as demonstrated in our study on patients with cleft palates.