To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors.
Design
Retrospective analysis of patient records and evaluation of preoperative initial photographs.
Setting
Tertiary craniofacial center.
Participants
Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007.
Interventions
The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate.
Main outcome measures
Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated.
Results
Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association (P ≤ .05) between the fistulas and initial cleft width (P = .0003), intraoperative problems (P = .0037), and postoperative problems (P = .00002).
Conclusions
The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.
AgrawalK.Cleft palate repair and variations. Indian J Plast Surg.2009; 42: 102–109.
3.
AmaratungaN.A.Occurrence of oro-nasal fistulas in operated cleft palate patients. J Oral Maxillofac Surg.1988; 46: 834–837.
4.
American Cleft Palate-Craniofacial Association.Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. Cleft Palate Craniofac J.1993; 30(suppl): S1–16.
5.
AnderssonE.M.SandvikL.SembG.AbyholmF.Palatal fistulas after primary repair of clefts of the secondary palate. Scand J Plast Reconstr Surg Hand Surg.2008; 46: 296–299.
6.
BekereciogluM.IsikD.BulutO.Comparison of the rate of palatal fistulation after two-flap and four-flap palatoplasty. Scand J Plast Reconstr Surg Hand Surg.2005; 39: 287–289.
BertierC.E.TrindadeI.E.K.Silva FilhoO.G.Cirurgias primárias de lábio e palato. In: TrindadeI.E.K.Silva FilhoO.G., coord. Fissuras labiopalatinas: Uma abordagem interdisciplinar.São Paulo: Santos; 2007: 73–86.
9.
BillmireD.A.Surgical management of clefts and velopharyngeal dysfunction. In: KummerA.W., ed. Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance.Clifton Park, NY: Thomson Delmar Learning; 2008: 401–424.
10.
BresnickS.WalkerJ.Clarke-SheehanN.ReinischM.D.Increased fistula risk following palatoplasty in Treacher Collins syndrome. Cleft Palate Craniofac J.2003; 40: 280–283.
11.
CarstensM.Management of palatal fistulae. Indian J Plast Surg.2011; 44: 46–49.
CohenS.R.KalinowskiJ.LaRossaD.RandallP.Cleft palate fistulae: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg.1991; 87: 1041–1047.
14.
DiahE.LoL-JYunC.WangR.WahyuniL.K.ChenY-R. Cleft oral fistula: a review of treatment results and a surgical management algorithm proposal. Chang Gung Med J.2007; 30: 529–537.
15.
Di NinnoCQMS. O efeito do vedamento da fistula de palato sobre a ressonância da fala de indivíduos com fissura de palato.Bauru, Brazil: Faculdade de Odontologia de Bauru-USP;2000. Thesis.
16.
EmoryR.E.ClayR.P.BiteU.JacksonI.T.Fistula formation and repair after palatal closure: an institutional perspective. Plast Reconstr Surg.1997; 99: 1535–1538.
17.
FreitasJ.A.Dalben GdaS.SantamariaM.JrFreitasP.Z.Current data on the characterization of oral clefts in Brazil. Braz Oral Res.2004; 18: 128–133.
HellingE.R.DevV.R.GarzaJ.BaroneC.NelluriP.WangP.T.H.Low fistula rate in palatal clefts closed with the Furlow technique using decellularized dermis. Plast Reconstr Surg.2006; 117: 2361–2365.
20.
InmanD.S.ThomasP.HodgkinsonP.D.ReidC.A.Oro-nasal fistula development and velopharyngeal insufficiency following primary cleft palate surgery - an audit of 148 children born between 1985 and 1997. Br J Plast Surg.2005; 58: 1051–1054.
21.
KhoslaR.K.MabryK.CastiglioneC.L.Clinical outcomes of the Furlow z-plasty for primary cleft palate repair. Cleft Palate Craniofac J.2008; 45: 501–510.
22.
LandheerJ.A.BreugemM.D.van der MolenM.Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure. Cleft Palate Craniofac J.2010; 47: 623–630.
23.
LaRossaD.JacksonO.H.KirshnerR.E.LowD.W.SolotC.B.CohenM.A.. The children's hospital of Philadelphia modification of the Furlow double-opposing z-palatoplasty: long term speech and growth results. Clin Plast Surg.2004; 31: 243–249.
24.
Lohmander-AgerskovA.FriedeH.SoderpalmE.LiljaJ.Residual clefts in the hard palate: correlation between cleft size and speech. Cleft Palate Craniofac J.1997; 34: 122–128.
MurthyJ.Descriptive study of management of palatal fistula in one hundred and ninety-four cleft individuals. Indian J Plast Surg.2011; 44: 41–46.
27.
MusgraveR.H.BremnerJ.C.Complications of cleft palate surgery. Plast Reconstr Surg.1960; 26: 180–189.
28.
MuzaffarA.R.ByrdH.S.RohrichR.J.JohnsD.F.LeBlancD.BeranS.J.. Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair. Plastic Reconstr Surg.2001; 108: 1515–1518.
29.
NolletP.J.KatsanosC.Van't HofM.A.Kuijpers-VagtmanA.M.Treatment outcome in unilateral cleft lip and palate evaluated with the Goslon Yardstick: a meta-analysis of 1236 patients. Plast Reconstr Surg.2005; 116: 1255–1262.
30.
OnealR.M.Oronasal fistulas. In: GrabbW.C.RosensteinS.W.BzochK.R., editors. Cleft Lip and Palate: Surgical, Dental and Speech Aspects.Boston: Little, Brown; 1971: 490–498.
31.
OzawaT.O.Avaliação dos efeitos da queiloplastia e palatoplastia primária sobre o crescimento dos arcos dentários de crianças com fissura transforame incisivo unilateral aos 5 ~ 6 anos de idade.Araraquara, Brazil: Faculdade de Odontologia de Araraquara-UNESP;2001. Thesis.
32.
ParwazM.A.SharmaR.K.ParasharA.NandaV.BiswasG.MakkarS.Width of cleft palate and postoperative palatal fistula—do they correlate?J Plast Reconstr Aesthet Surg.2009; 12: 1559–1563.
33.
PhuaY.S.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: 172–178.
34.
SembG.ShawW.C.Simonart's band and facial growth in unilateral clefts of the lip and palate. Cleft Palate Craniofac J.1991; 28: 40–46.
35.
Silva FilhoO.G.CristovãoR.M.SembG.Prevalence of a soft tissue bridge in a sample of 2014 patients with complete unilateral clefts of the lip and palate. Cleft Palate Craniofac J.1994; 31: 122–124.
36.
Silva FilhoO.G.FreitasJ.A.S.Caracterização morfológica e origem embriológica. In: TrindadeI.E.K.Silva FilhoO.G., coord. Fissuras labiopalatinas: Uma abordagem interdisciplinar.São Paulo: Santos; 2007: 17–49.
37.
Silva FilhoO.G.FreitasJ.A.S.OkadaT.Fissuras labiopalatinas: diagnóstico e uma filosofia interdisciplinar de tratamento. In: PintoV.G., coord. Saúde bucal coletiva.São Paulo: Santos. 2000. p. 481–527.
38.
SmithD.M.VecchioneL.JiangS.FordM.DeleyiannisF.W.B.HaralamM.A.. The Pittsburgh fistula classification system: a standardized scheme for the description of palatal fistulas. Cleft Palate Craniofac J.2007; 44: 590–594.
39.
WilliamsW.N.SeagleM.B.Pegoraro-KrookM.I.SouzaT.V.GarlaL.SilvaM.L.. Prospective clinical trial comparing outcome measures between Furlow and von Langenbeck palatoplasties for UCLP. Ann Plast Surg.2011; 66: 154–163.
YuC.C.ChenP.K.ChenY.R.Comparison of speech results after Furlow palatoplasty and von Langenbeck palatoplasty in incomplete cleft of the secondary palate. Chang Gung Med J.2001; 24: 628–632.
