Challenges to achieving low palatal fistula rates following primary cleft palate repair: experience of an institution in Uganda

Abstract

ObjectiveTo determine frequency of palatal fistula following primary cleft palate repair and the associated factors as a measure of cleft palate repair outcome and its challenges at a cleft centre in Uganda.ResultsBetween May and December 2016, 54 children with cleft palate were followed up at Comprehensive Rehabilitation services of Uganda (CoRSU) hospital, from time of primary cleft palate repair until at least 3 months postoperative to determine whether they developed palatal fistula or not. Frequency of palatal fistula was 35%. Factors associated with increased fistula formation were cleft width wider than 12 mm (p = 0.006), palatal index greater than 0.4 (p = 0.046), presence of malnutrition at initial outpatient assessment (p = 0.0057) and at time of surgery (p = 0.008), two-stage palate repair (p = 0.005) and postoperative infection (p = 0.003). Severe clefting (palatal index greater than 0.4) was seen in 74% of patients and malnutrition (Low weight for age) seen in 48% of patients. Palatal fistula rates at our institution were high compared to reports in literature. The high proportions of severe clefting and malnutrition observed in our population that was also poor and unable to afford feeding supplements increased likelihood of fistula formation and posed challenges to achieving low fistula rates in our setting.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3459-6) contains supplementary material, which is available to authorized users.

Malnutrition as a Risk Factor in Cleft Lip and Palate Surgery

“…In that study, 10/15 (67%) severely underweight children had a postoperative fistula, compared to 4/13 (31%) underweight children and 5/26 (19%) of nonunderweight children. However, as noted above, in that study, 24% of patients were underweight, and 15% were severely underweight by WHO standards, compared to the lower numbers of each seen in our patient population 21 …”

“…One study from England by Pandya et al, of 147 patients found that 38% of patients with CLP had failure to thrive at the time of surgery, 20 whereas a study from Uganda by Cubitt et al, of 243 patients noted that, on average, patients with cleft lip and palate had a WFA Z‐score of −3.21 at time of surgery, compared to a WFA Z‐score of 0.99 in a group of 78 children without CLP undergoing different procedures 15 . Another study in Uganda by Katusabe et al, of 78 children with cleft palate found 24% were underweight and 15% were severely underweight by WHO standards of WFA at the time of surgery 21 . A recent study from Brazil found that 12.9% of all patients with CLP under the age of two were acutely malnourished, and 14.4% chronically malnourished using WHO growth standards 22 …”

Frequency and Predictors of Fistulae Occurrence after One Stage Repair with Radical Muscle Dissection for Complete Cleft Palate

“…One of the indicators of successful cleft palate repair is a reduced incidence of palatal fistula. 19.…”

“…Some studies reported absence of fistula development after cleft palate repair that supports our results. 19,20 This could be linked to the exclusion of patients with very wide palatal clefts and smaller number of the study group. Some studies reported that fistula rate was higher for the more sever degree of clefting.…”

The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review

“…Another challenge in cleft care in SSA is malnutrition, which prevents the opportunity to receive care if the patient is in such poor condition that they are not a surgical candidate (Massenburg et al, 2016). Of note, if cleft palate repairs are performed in malnourished patients, there is an increased risk of palatal fistula postsurgery (Katusabe et al, 2018). Additionally, patients often do not have the financial resources to seek care (Massenburg et al, 2016;Bello et al, 2018).…”