Analysis of the Intrinsic Predictors of Oronasal Fistula in Primary Cleft Palate Repair Using Intravelar Veloplasty

Abstract

Introduction: The purpose of the present study was to investigate various factors of cleft palate and to analyze their effect on fistula occurrence following palatal muscle repair using intravelar veloplasty. Methods: A retrospective review of patients who underwent palatoplasty was performed. Primary palatoplasty was performed by a single surgeon in a single center. A total of 165 patients who underwent palatoplasty were enrolled. Primary palatoplasty with levator veli palatini muscle repair using intravelar veloplasty was performed. Three extrinsic factors (age, gender, and body weight) and 6 intrinsic factors (cleft width, ratio of cleft width to intermaxillary tuberosity distance, cleft anterior margin shape, uvula position, cleft lip, and radical intravelar veloplasty) were analyzed. Results: Palatal fistula occurred in 11 (6.67%) patients. The occurrence of fistula was significantly correlated with a specific Veau classification, that is, type II ( P = .041). Fistula tended to occur more frequently with a wide cleft palate ( P = .063), and the high-risk cutoff value of the width was 7.75 mm. Conclusions: A larger cleft width tended to increase the occurrence of fistula. Close observation and information about the higher risk of fistula formation should be given to patients with a large cleft width who underwent intravelar veloplasty.

Filling the Void: Use of the Interpositional Buccal Fat Pad to Decrease Palatal Contraction and Fistula Formation

“…However, the utilization of the buccal fat pad preferentially for difficult and challenging palate repairs should have resulted in a bias toward poorer outcomes and we would have expected a higher than average fistula rate. The findings from Yi et al 34 support the assumption that wider palates have a higher than average expected rate of fistula formation. In addition, 45% of the patients in this study had an associated comorbidity such as Robin Sequence indicating an increased level of difficulty in palatal repair.…”

“…More specifically, clefts wider than 7.75 mm were considered high risk clefts. 34 Many studies have attempted to describe the risk factors most associated with development of post-operative complications, but this paper was one of the first to demonstrate the point at which cleft width becomes an independent predictor for failure of the repair.…”

Cleft Palate Repair by Otolaryngologist‐Head and Neck Surgeons: Risk Factors for Postoperative Fistula

“…Many of these prior studies span decades, only examine the results of one or two surgeons, and amount to a summation of surgical results amassed over one's career. 3,10,11,14,17,20,21 Recently there have been more large scale reviews, including a systematic review of 44 studies, reporting fistula incidence rates ranging from 0 to 35.5 percent. 7 Historically higher rates of fistula incidence have been reported among patients with syndromes.…”

“…Large scale studies on the incidence and contributing factors of palatal fistula development have most often focused on the experience of a single surgeon or single institution. [8][9][10][11][12][13][14] More recent systematic reviews and large de-identified database studies have suggested that the extent of the palatal defect (Veau classification) is, in fact, the most important factor in determining the risk of palatal fistula, whereas other smaller studies have pointed to diagnosis of a syndrome, surgeon experience, or a surgeon's having completed craniofacial fellowship training following a General Plastic Surgery residency as characteristics that may influence the rate of postoperative palatal fistula. 3,5,9,10,15,16 Over the last few decades, the number of Otolaryngologist-Head and Neck Surgeons who regularly perform cleft lip and palate surgeries has been growing; today approximately 10% of the roughly 180 multidisciplinary cleft and craniofacial teams nationwide are led by Otolaryngologists.…”

Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

“…The presence of this abnormal connection between the nasal and oral cavities may result in nasal regurgitation and affect normal speech function; hence, oronasal fistula warrants timely surgical repair to avoid negative impacts on speech development (Cohen et al, 1991; Bureau et al, 2001; Mapar et al, 2019). Multiple risk factors for the development of oronasal fistula after cleft palate repair have been reported, including higher Veau classifications, concomitant cleft lip, greater cleft width, and lower-volume surgeons (Cohen et al, 1991; Kahraman et al, 2014; Bykowski et al, 2015; Hosseinabad et al, 2015; Jodeh et al, 2019; Yi et al, 2020).…”