Comparison Between Two Mucoperiosteal Flap Techniques in Repairing Small-to-Medium-Sized Hard Palate Postpalatoplasty Fistulas

Abstract

Objective

Postpalatoplasty fistula management is challenging with considerable recurrence rate. Currently, there is a lack of consensus on the optimal technique for fistula repair. Both single-layer and double-layer closures were practiced in our cleft center to manage hard palate fistulas. This study retrospectively compares the two techniques and screened factors correlated with prognosis.

Methods

Patients with postpalatoplasty small-to-medium-sized fistulas treated surgically between April 2013 and January 2023 at a tertiary hospital-based cleft center were reviewed. Hard palate fistulas managed by either single-layer or double-layer mucoperiosteal flaps and followed for at least 6 months were enrolled. The shape, size, and symptoms of the fistulas were recorded both before the surgery and at the follow-up. Both univariate and multivariate analyses were performed to explore correlation between recurrence and factors including surgical technique, gender, age at surgery, primary lip and cleft palate type, presence of unrepaired cleft alveolus, as well as fistula size and length-width ratio.

Results

A total of 144 cases were included, with 57 receiving single-layer closure and 87 receiving double-layer closure. No significant difference in recurrence rates was observed between the techniques. Age at surgery and the length-width ratio of the fistula were identified as significant correlations with recurrence. Age above 11.5 years and length-width ratio below 1 were suggested as risk factors for fistula recurrence.

Conclusion

Single-layer and double-layer mucoperiosteum repair demonstrated comparable efficiency in managing small-to-medium-sized hard palate fistula. Length-width ratio of the fistula and age at operation were significant prognostic factors for fistula recurrence.