Fistula Rate after Primary Repair of Cleft Palate: Novel Exposed Inverted Horizontal Mattress Nasal Closure

Abstract

Objectives:

Discuss options for midline nasal suture during 2-flap palatoplasty (2FPP). Compare effects of patient demographics, Veau class, associated syndromes, surgeon experience, and use of a previously unreported exposed inverted horizontal mattress suture for nasal mucoperiosteal closure on fistula rates and velopharyngeal insufficiency (VPI).

Methods:

Retrospective case series review of all children who underwent 2FPP by the attending surgeon (J.J.M.). Fifty-five consecutive patients were analyzed over a 5.5-year period. Study variables were obtained from multidisciplinary craniofacial/cleft records. All patients underwent 2FPP with intravelar veloplasty using the suture technique described herein. No patients were excluded from primary review and statistical analysis.

Results:

Eighty-nine percent of patients were Veau class 2 or 3. Twenty-four (44%) patients had an associated syndrome. Patients with a lower Veau class were 3.6 times more likely to have an associated syndrome (P = .0001). Two (3.6%) patients developed a fistula. There was no association between Veau class, presence of an associated syndrome, or use of dermal allograft with the development of a fistula (P = 1.0, all). Postoperative VPI was noted in 11 (20%) patients, without association between Veau class, syndrome, or dermal allografting (P = 1.0, .74, and .45, respectively). Repairs in the first half of the patient sample had a 10-fold increased risk of postoperative VPI (P =.0024).

Conclusion:

Our use of an exposed inverted horizontal mattress suture for nasal mucoperiosteal closure during 2FPP appears safe and is comparable with the lowest published rates of postoperative fistula and VPI. Further standardized studies are needed in this area.