A statistical analysis of incidence, etiology, and management of palatal fistula

Abstract

Objective: The purpose of this study was to retrospectively review the incidence, profile, and the management of palatal fistula occurring in patients operated for cleft palate in our institute. Materials and Methods: A retrospective analysis was performed on all cleft palatal fistula patients who presented during the period from August 2007 to October 2017, to classify their site, age of presentation, surgery performed, and outcome. A record of the type of cleft palate and previous palatoplasty was also obtained. The outcome in terms of incidence and fistula formation depending on Veau's classification was analyzed. Results: Twenty-two patients reported with palatal fistula during this period. The incidence of fistula formation of our institute was 9.6%. Incisive foramen (13/22) was the most common site of fistula formation. Among various techniques used, local and buccal flaps were found to be useful in a maximum number of cases (14/22). The rate of fistula recurrence was 18.2% (4/22). On retrospective analysis of our institutional data, it was found that the incidence of cleft palate fistula was significantly higher in clefts with Veau Types III and IV (13/18) as compared to Veau Types I and II (5/18). Conclusion: This study shows that the fistula rate of our institution was 9.6%. Complete clefts (unilateral or bilateral) involving both primary and secondary palates predispose more to fistula formation.

Evaluation of Prognostic Factors for Palatal Fistulae after Cleft Lip and Palate Surgery in a North-Western Romanian Population over a 10-Year Period

“…The rate of fistula recurrence was 18.2%. The same study found that complete clefts that involved both the primary and the secondary palate lead to more oro-nasal communications [ 12 ].…”

“…Another study [ 12 ], performed on 129 consecutive non-syndromic patients, revealed an incidence of fistulae after palate closure of 23%. The type of palate closure influenced the frequency of fistulae: 10% (Furlow), 22% (von Langenbeck), and 0% (Dorrance).…”

Current insights in the preclinical study of palatal wound healing and oronasal fistula after cleft palate repair

“…Clinically, a common site of poor palatal wound healing was the anterior palate, mainly due to the anatomical complexity of this area, particularly on the nasal side, where an inadequate issue often led to the failure of closure ( Figures 1B1–B3 ). Another common site was the junction of the hard palate and soft palate, a site often considered to be the area of greatest tension ( Figure 1B4 ) ( Raoul and Ferri, 2007 ; Garg et al, 2019 ; Ha et al, 2020 ).Thus adequate tension reduction was the most crucial point in preventing poor palatal wound healing and tension-free suturing was a fundamental principle of cleft palate surgery ( Agir et al, 2015 ; Elsherbiny and Grant, 2017 ).…”

“…Poor palatal wound healing could lead to oronasal fistula (ONF), resulting from extensive tension, infection, or hematoma ( Hu and Rousso Joseph, 2020 ; Pollard et al, 2020 ). Oronasal fistula (ONF) was a common complication after cleft palate repair, which manifested as abnormal communication between oral and nasal cavities ranging from the alveolar process to the uvula ( Honnebier et al, 2000 ; Mahajan et al, 2018 ; Alonso et al, 2019 ; Pollard et al, 2020 ), which could cause food reflux, unclear pronunciation and impaired velopharyngeal function, which affected the patient’s quality of life ( Mahajan et al, 2018 ; Garg et al, 2019 ; Huang et al, 2023b ). The incidence of ONF after cleft palate repair was up to 55% and the recurrence rate of ONF was up to 43% due to the cleft width, Veau types, and surgical techniques ( Shankar et al, 2018 ; Sakran et al, 2022 ; Sakran et al, 2023a ; Sakran et al, 2023b ; Sakran et al, 2023c ; Huang et al, 2023a ).…”

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis

“…This can lead to a cascade of complications including compromised speech, dysphagia, nasal regurgitation, and impaired maxillofacial growth. The rate of postoperative palatoplasty failure ranges from 2.4% to 55%, related to the cleft width, Veau type, and surgical repair method [4–7,8 ▪ ]. Recurrent palatal defects can be extremely challenging to manage due to factors such as scarring and local tissue hypovascularity, leading to flap loss and wound dehiscence.…”