Comparison of the rate of palatal fistulation after two-flap and four-flap palatoplasty

Abstract

We studied 73 repairs of cleft palate (48 cleft lip and palate and 25 isolated cleft palate) done during a 7-year period (January 1996-October 2002) by the same plastic reconstructive surgeon. Two-flap or four-flap palatoplasty techniques were used to provide tension-free, three-layer repairs for patients with cleft palate. Their ages ranged from 10-244 months (mean 27). The postoperative follow-up period ranged from 6 to 60 months (mean 21). There was a palatal fistulation rate of 7% (5/73). There were two fistulas after two-flap palatoplasty (5%, 2/39), and three fistulas after four-flap palatoplasty (9%, 3/34). The mean diameter was 7.8 mm (range 5.1 to 13). There was no significant difference between the two techniques.

The Importance of Radical Intravelar Veloplasty during Two-Flap Palatoplasty

“…These results are in agreement with other articles published using a similar technique. 6,28 The other primary goal in palatoplasty is to enable good speech development. Levator muscle repair is one of the key components of this technique and a fundamental element for achieving adequate speech results.…”

Fistula Incidence after Primary Cleft Palate Repair

“…1). There were five randomized controlled trials 35,37,42,48,55 and 39 nonrandomized studies, [1][2][3]5,9,13,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34]36,[38][39][40][41][43][44][45][46][47][49][50][51][52][53][54]56,57 of which 10 were comparative studies and 29 were noncomparative. The mean Detsky score for the randomized controlled trials was 14, with two studies considered to be of high quality.…”

An Evidence-Based Approach to Cleft Palate Repair

“…The authors recommended the two-flap repair for cleft palate repair. 23 To address the inherent shortening of the palate that occurs secondary to scar formation during the healing process, some authors have utilized a simultaneous pharyngeal flap at the time of palate repair; however, in one randomized controlled study focusing on submucous cleft palate, no differences were noted between palatoplasty with intravelar veloplasty and palatoplasty with concomitant pharyngoplasty (Level II Evidence). 24 Another study noted good speech outcomes when combining a Furlow Z-plasty with velopharyngeal reconstruction in the form of either palatopharyngeus flaps or a sphincteroplasty (Level V Evidence).…”