Cleft palate (CP) is a common congenital malformation with numerous popular and effective techniques described for operative repair. Despite this, the fistula rate following primary as well as secondary palate repairs remains high with reports ranging between 15% and 55% fistula rate. We conducted a systematic meta-analysis review to evaluate the effect of platelet rich products (PRPs) on rate of fistula formation given its well documented association with accelerated wound healing.
Design
Meta-analysis systematic review.
Setting
Articles identified through MEDLINE, Embase, Pubmed, Google Scholar, Web of Science, Scopus, Cochrane, References, related articles.
Patients, Participants
Patients in randomized controlled trials undergoing primary or secondary CP repair.
Interventions
PRP vs no PRP.
Main Outcome Measure
Rate of fistula formation.
Results
Five articles with a total of 164 patients were identified and included in our final meta-analysis. There were 82 patients in each experimental and control groups. A total 22 patients experienced a fistula. Fistula rates in PRP and non-PRP groups were 4.9% (n = 4) and 22.0% (n = 18). The difference of fistula rates between PRP and non-PRP groups was statistically significant (pooled risk ratio: 0.32 (0.12—0.82, p = .02) on our overall pooled meta-analysis.
Conclusion
In our meta-analysis review, PRP was found to significantly reduce fistula rates after primary or secondary palatoplasty in CP repair. PRP may represent an effective intra-operative adjunct to conventional surgical management and repair of CP to reduce the risk of fistula formation. Further investigation is required to explore the impact of the use of PRP on other post-operative parameters for CP.
ParkMSSeoHJBaeYC. Incidence of fistula after primary cleft palate repair: A 25-year assessment of one surgeon's experience. Arch Plast Surg. 2022;49(1):43‐49.
9.
ChenJYangRYinJShiBHuangH. Current insights in the preclinical study of palatal wound healing and oronasal fistula after cleft palate repair. Front Cell Dev Biol. 2023;11:1271014. doi:10.3389/fcell.2023.1271014
10.
MazzoniEIaquintaMRLanzillottiC, Mazziotta C, Maritati M, Montesi M, Sprio S, Tampieri A, Tognon M, Martini F.Bioactive materials for soft tissue repair. Front Bioeng Biotechnol. 2021;9:613787.
11.
Vásquez-ÁlvarezMWangQZapataU. The use of platelet concentrates in the reconstruction of the alveolar cleft defect: A systematic review and meta-analysis. Cleft Palate Craniofac J. 2024;62(4):633-652.
12.
OliverJDJiaSHalpernLR, Graham EM, Turner EC, Colombo JS, Grainger DW, D'Souza RN. Innovative molecular and cellular therapeutics in cleft palate tissue engineering. Tissue Eng Part B Rev. 2021;27(3):215‐237.
13.
ThrivikramanGAthirasalaATwohigCBodaSKBertassoniLE. Biomaterials for craniofacial bone regeneration. Dent Clin North Am. 2017;61(4):835‐856.
14.
NeoviusEEngstrandT. Craniofacial reconstruction with bone and biomaterials: Review over the last 11 years. J Plast Reconstr Aesthet Surg. 2010;63(10):1615‐1623.
15.
PaichitrojjanaAPaichitrojjanaA. Platelet rich plasma and its use in hair regrowth: A review. Drug Des Devel Ther. 2022;16(Continuous Model):635‐645.
16.
XuJGouLZhangPLiHQiuS. Platelet-rich plasma and regenerative dentistry. Aust Dent J. 2020;65(2):131‐142.
17.
HersantBLa PadulaSSidAhmed-MeziMRodriguezAMMeningaudJP. Use of platelet-rich plasma (PRP) in microsurgery. J Stomatol Oral Maxillofac Surg. 2017;118(4):236‐237.
18.
SantosSSigurjonssonÓECustódioCAManoJ. Blood plasma derivatives for tissue engineering and regenerative medicine therapies. Tissue Eng Part B Rev. 2018;24(6):454‐462.
19.
CarterMJFyllingCPParnellLK. Use of platelet rich plasma gel on wound healing: A systematic review and meta-analysis. Eplasty. 2011;11(Identifier):e38.
20.
Soliman Mohammed SolimanAYMElsayedAAHashishMASaleh MohammedMF. Evaluation of autologous platelet rich fibrin in cleft palate repair. The Egyptian J Hospital Med. 2022;77(5):5752-5758.
21.
El-AnwarMWNofalAAKhalifaMQuribaAS. Use of autologous platelet-rich plasma in complete cleft palate repair. Laryngoscope.2016;126(7):1524‐1528.
22.
EmaraDMakeenKAboulHassanM. PRP Injection effect on palatal Fistula repair: A comparative study. The Egyptian Journal of Plastic and Reconstructive Surgery. 2020;42(2):337‐344.
23.
YehyaAGIElMonemMA, Gamaan I, ELdsoky I, Alahmar M, Seddik A, Ziada A. (Modified platelet rich plasma (PRP) technique in repair of primary cleft palate. Prensa Med Argent. 2020;106(3):197.
24.
MoherDLiberatiATetzlaffJAltmanDG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097.
25.
CovidencePty Ltd. Covidence systematic review software [computer program]. Melbourne, Australia: Covidence Pty Ltd; 2025. Available at www.covidence.org.
26.
SterneJACSavovićJPageMJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, et al. Rob 2: A revised tool for assessing risk of bias in randomised trials. Br Med J.2019;366(4):l4898.
27.
GuyattGOxmanADAklEA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, et al.GRADE Guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383‐394.
28.
HaddawayNRPageMJPritchardCCMcGuinnessLA. PRISMA2020: An R package and shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev. 2022;18(2):e1230.
29.
SadhuP. Oronasal fistula in cleft palate surgery. Indian J Plast Surg. 2009;42(Suppl):S123‐S128.
30.
TramsEKulinskiKKozar-KaminskaKPomianowskiSKaminskiR. The Clinical Use of Platelet-Rich Plasma in Knee Disorders and Surgery-A Systematic Review and Meta-Analysis. Life (Basel). 2020;10(6):72-77.
31.
BoltonL. Platelet-Rich plasma: Optimal use in surgical wounds. Wounds. 2021;33(8):219‐221.
32.
LeeKCHalepasSWuBWChuangSK. For patients with isolated cleft palate does revision palatoplasty have an increased risk of inpatient complication compared to primary palatal repair?Cleft Palate Craniofac J. 2021;58(1):72‐77.
33.
KimHY. Statistical notes for clinical researchers: Type I and type II errors in statistical decision. Restor Dent Endod. 2015;40(3):249‐252.
34.
NadonFChaputBPérisséJde BérailALauwersFLopezR. Interest of mineralized plasmatic matrix in secondary autogenous bone graft for the treatment of alveolar clefts. J Craniofac Surg. 2015;26(7):2148‐2151.
35.
CohenSRKalinowskiJLaRossaDRandallP. Cleft palate fistulas: A multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg.1991;87(6):1041‐1047.
36.
PhuaYSde ChalainT. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: An audit of 211 children born between 1990 and 2004. Cleft Palate Craniofac J. 2008;45(2):172‐178.
37.
SakranKAWuMAlkebsiK, Mashrah MA, Al-Rokhami RK, Wang Y, Mohamed AA, Elayah SA, Al-Sharani HM, Huang H, et al. The sommerlad-furlow modified palatoplasty technique: Postoperative complications and implicating factors. Laryngoscope.2023;133(4):822‐829.
38.
BullerMJodehDQamarFWrightJMHalseyJNRottgersSA. Cleft palate fistula: A review. Eplasty. 2023;23(3):e7.
39.
EliasonMJHadfordSGreenLReevesT. Incidence of Fistula formation and velopharyngeal insufficiency in early versus standard cleft palate repair. J Craniofac Surg. 2020;31(4):980‐982.
40.
NaiduPYaoCAChongDKMageeWP. Cleft palate repair: A history of techniques and variations. Plast Reconstr Surg Glob Open. 2022;10(3):e4019.
41.
WangH. Biomaterials in medical applications. Polymers (Basel). 2023;15(4):847-847.
42.
NiermeyerWLRodmanCLiMMChiangT. Tissue engineering applications in otolaryngology-the state of translation. Laryngoscope Investig Otolaryngol. 2020;5(4):630‐648.
43.
TevlinRMcArdleAAtashrooD, Walmsley GG, Senarath-Yapa K, Zielins ER, Paik KJ, Longaker MT, Wan DC. Biomaterials for craniofacial bone engineering. J Dent Res.2014;93(12):1187‐1195.
44.
ColazoJMEvansBCFarinasAFAl-KassisSDuvallCLThayerWP. Applied bioengineering in tissue reconstruction, replacement, and regeneration. Tissue Eng Part B Rev. 2019;25(4):259‐290.
45.
Martín-Del-CampoMRosales-IbañezRRojoL. Biomaterials for cleft lip and palate regeneration. Int J Mol Sci. 2019;20(9):2176.
46.
EvertsPOnishiKJayaramPLanaJFMautnerK. Platelet-Rich plasma: New performance understandings and therapeutic considerations in 2020. Int J Mol Sci. 2020;21(20):7794.
47.
WhiteCBrahsADortonDWitfillK. Platelet-Rich plasma: A comprehensive review of emerging applications in medical and aesthetic dermatology. J Clin Aesthet Dermatol.2021;14(11):44‐57.
48.
LiangYLiJWangY, He J, Chen L, Chu J, Wu H. Platelet rich plasma in the repair of articular cartilage injury: A narrative review. Cartilage. 2022;13(3):19476035221118419.
49.
LiuBJeongHJYeoJHOhJH. Efficacy of intraoperative platelet-rich plasma augmentation and postoperative platelet-rich plasma booster injection for rotator cuff healing: A randomized controlled clinical trial. Orthop J Sports Med. 2021;9(6):23259671211006100.
50.
TanejaMK. Role of platelet rich plasma in tympanoplasty. Indian J Otolaryngol Head Neck Surg. 2020;72(2):247‐250.
51.
WooP. Platelet-rich plasma in treatment of scar, atrophy, and sulcus: Short- and long-term results. Laryngoscope Investig Otolaryngol. 2023;8(5):1304‐1311.
52.
LacciKMDardikA. Platelet-rich plasma: Support for its use in wound healing. Yale J Biol Med. 2010;83(1):1‐9.
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