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

Area of Science:

• Plastic Surgery
• Surgical Training
• Craniofacial Surgery

Background:

• Cleft palate repair presents significant challenges for surgical residency training.
• Limited access, small cavities, and delicate tissue handling contribute to complications like oronasal fistula (ONF) in inexperienced surgeons.
• Hands-on experience is critical for effective training.

Purpose of the Study:

• To identify criteria for selecting appropriate cleft palate surgery cases for chief residents.
• To analyze factors influencing oronasal fistula (ONF) rates in primary palatoplasty.
• To evaluate the role of specific techniques in mitigating ONF risk during surgical training.

Main Methods:

• Retrospective study of 186 primary palatoplasty patients (Jan 2012 - Dec 2021).
• Procedures performed by chief residents under surgeon supervision.
• Analysis focused on cleft width, preoperative interventions, and ONF occurrence.

Main Results:

• The 2-flap palatoplasty technique resulted in a 22.04% postoperative ONF rate.
• Cleft width exceeding 11.5 mm significantly increased ONF likelihood (5.23 times, P=0.001).
• Preoperative nasoalveolar molding and buccal fat flaps reduced ONF risk (OR 0.34, 0.06; P=0.035, 0.006).

Conclusions:

• Surgical training requires practical experience on patients, balancing benefits and risks.
• Careful case selection is essential for optimizing outcomes in cleft palate surgery training.
• Specific preoperative interventions can mitigate ONF risk, aiding resident training.