Difficulty Index-Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience

Saralaya, Shruthi; Desai, Anil Kumar; Kumar, Niranjan

doi:10.1016/j.joms.2018.12.005

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…Elsherbiny and Grant (2017) reported a 5% (2/37) fistula recurrence rate with this approach, advocating extensive undermining of the entire oral mucoperiosteum to facilitate tension-free closure. Similar results were reported by Denadai et al (2020; 14% recurrence [9/63]) and by Saralaya et al (2019; 4.5% recurrence [1/22]) using local tissue advancement. Taken together, these results suggest that 2-layer closure using local tissue advancement is an effective first-line surgical technique for closure of small- and medium-size palate fistulae.…”

Section: Discussionsupporting

confidence: 89%

“…Surgeons in the present study recommended that tongue flaps only be used if the patient will cooperate and would rarely use them before the age of 5 years. Recent retrospective studies of fistula repair with tongue flaps have suggested fistula recurrence rates of 8% to 10% (Mahajan et al, 2014; Sodhi et al, 2014; Strujak et al, 2016), although Saralaya et al (2019) reported a recurrence rate of 30% (4/13) for more complex fistulae. Despite the robustness of tongue flaps, a recent study comparing FAMM flaps and tongue flaps for anterior palatal fistula closure found that the 2 approaches had similar effectiveness (0% recurrence), but the FAMM flap required less operative time and had fewer postoperative speech and feeding issues (Sohail et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…The overall incidence of oronasal fistula after cleft palate repair is between 5% and 6%, although fistula rates ranging from 0% to 60% have been reported (Hardwicke et al, 2014; Jodeh et al, 2019; Stein et al, 2019). Fistula occurrence is related to several factors, including cleft type and severity, surgeon experience, and operative technique (Antonelli et al, 2011; Hardwicke et al, 2014; Bykowski et al, 2015; Jodeh et al, 2019; Saralaya et al, 2019; Stein et al, 2019). Unfortunately, once a fistula forms, the risk of recurrence after surgical repair is high (Schultz, 1986; Losee et al, 2008; Bykowski et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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A Toolbox of Surgical Techniques for Palatal Fistula Repair

Rothermel

Lundberg

Samson

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: To provide an inventory of oronasal fistula repair techniques alongside expert commentary on which techniques are appropriate for each fistula type. Design: A 4-stage approach was used to develop a consensus on surgical techniques available for fistula repair: (1) in-person discussion of oronasal fistula cases among cleft surgeons, (2) development of a schema for fistula management using transcripts of the in-person case discussion, (3) evaluation of the preliminary schema via a web-based survey of additional cleft surgeons, and (4) revision of the management schema using survey responses. Participants: Six cleft surgeons participated in the in-person case discussion. Eleven additional surgeons participated in the web-based survey. Participants had diverse training experiences, having completed residency and fellowship at 20 different hospitals. Results: A schema for fistula management was developed, organized by fistula location. The schema catalogues all viable approaches for each location. For fistulae involving the soft palate, the schema stresses the importance of evaluating for velopharyngeal insufficiency (VPI) and incorporating VPI management into fistula repair. For fistulae involving the hard palate, the schema separately enumerates the techniques available for nasal lining repair and for oral lining repair in each region. The schema also catalogues the diversity of approaches to lingual- and labioalveolar fistula, including variation in timing, orthodontic preparation, and simultaneous alveolar bone grafting. Conclusions: This study employed consensus methods to create a comprehensive inventory of available fistula repair techniques and to identify preferential techniques among a diverse group of surgeons.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Toolbox of Surgical Techniques for Palatal Fistula Repair

Rothermel

Lundberg

Samson

et al. 2020

The Cleft Palate-Craniofacial Journal

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“…Furthermore, the technique has been favored as it lengthens the soft palate, reduces the postsurgical anteroposterior scar contraction, and improves muscle mobility resulting in better velar function [16]. Pushback techniques, for example, the Veau Wardill--Kilner palatoplasty/VY-pushback that retro position the soft palate also result in good velopharyngeal function while leaving exposed hard palate bone; they have been associated with a high fistula rate because of the increased tension and the single nasal layer with incomplete oral closure anteriorly [17].…”

Section: Mitigating the Risk Of Oronasal Fistulasmentioning

confidence: 99%

“…Several studies have shown that for small-to-medium sized hard and soft palate fistulas, a two-layered closure using local advancement flaps was effective [17,27 ▪▪ ,32]. Velopharyngeal competence should be determined prior to the repair of the soft palate fistula.…”

Section: Mitigating the Risk Of Oronasal Fistulasmentioning

confidence: 99%

Prevention and management of oronasal fistulas

Othieno

Tatum

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review The aim of this article is to present the current opinion on the prevention and management of oronasal fistulas in cleft palate patients. Recent findings Though cleft palate repair has seen numerous modifications and improvements, oronasal fistulas remain one of the most common complications of palatoplasty. There are various techniques available for preventing and managing this complication. Summary Oronasal fistulas can be minimized by employing proper principles for palatoplasty. Once a fistula occurs, the repair technique should be appropriate for the fistula type. Oronasal fistula classifications, various repair techniques, tissue adjuncts, and biomaterials used in both the primary palate repair and oronasal fistula repair are discussed in this review.

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Surgical Management of Oronasal Fistula After Primary Cleft Palate Repair: Condition-Specific Protocol and Outcome

Denadai¹,

2022

Current Concept in Cleft Surgery

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Difficulty Index-Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience

Cited by 11 publications

References 14 publications

A Toolbox of Surgical Techniques for Palatal Fistula Repair

A Toolbox of Surgical Techniques for Palatal Fistula Repair

Prevention and management of oronasal fistulas

Surgical Management of Oronasal Fistula After Primary Cleft Palate Repair: Condition-Specific Protocol and Outcome

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