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

Opriș, Daiana; Opriș, Horia; Dinu, Cristian; Bran, Simion; Băciuț, Grigore; Armencea, Gabriel; Mitre, Ileana; Colosi, Horațiu Alexandru; Băciuţ, Mihaela

doi:10.3390/ijerph18147305

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…Severity of clefting, comorbid cleft lip, and Veau category of cleft have shown to themselves as some of the more predictive metrics of a patient's postoperative course. 24,25 The present study did not find a significant relationship between presence of comorbid cleft lip and need for surgery to correct VPI = 0.057). A 2-stage palate repair was associated with a significantly elevated need for surgery to correct VPI compared with a Furlow palatoplasty.…”

Section: Discussioncontrasting

confidence: 59%

“…Comorbid cleft lip was associated with a significantly higher rate of oronasal fistula development following primary palatoplasty. Severity of clefting, comorbid cleft lip, and Veau category of cleft have shown to themselves as some of the more predictive metrics of a patient's postoperative course 24,25 . The present study did not find a significant relationship between presence of comorbid cleft lip and need for surgery to correct VPI ( P = 0.057).…”

Section: Discussioncontrasting

confidence: 59%

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Longitudinal Speech and Fistula Outcomes Following Primary Cleft Palate Repair at a Single Institution

Phillips,

Galarza,

Sink

et al. 2024

Ann Plast Surg

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Introduction Fistula formation and velopharyngeal insufficiency (VPI) are complications of cleft palate repair that often require surgical correction. The goal of the present study was to examine a single institution's experience with cleft palate repair with respect to fistula formation and need for surgery to correct velopharyngeal dysfunction. Methods Institutional review board approval was obtained. Patient demographics and operative details over a 10-year period were collected. Primary outcomes measured were development of fistula and need for surgery to correct VPI. Chi-square tests and independent t tests were utilized to determine significance (0.05). Results Following exclusion of patients without enough information for analysis, 242 patients were included in the study. Fistulas were reported in 21.5% of patients, and surgery to correct velopharyngeal dysfunction was needed in 10.7% of patients. Two-stage palate repair was associated with need for surgery to correct VPI (P = 0.014). Furlow palatoplasty was associated with decreased rate of fistula formation (P = 0.002) and decreased need for surgery to correct VPI (P = 0.014). Conclusion This study reiterates much of the literature regarding differing cleft palate repair techniques. A 2-stage palate repair is often touted as having less growth restriction, but the present study suggests this may yield an increased need for surgery to correct VPI. Prior studies of Furlow palatoplasty have demonstrated an association with higher rates of fistula formation. The present study demonstrated a decreased rate of fistula formation with the Furlow technique, which may be due to the use of the Children's Hospital of Philadelphia modification. This study suggests clinically superior outcomes of the Furlow palatoplasty over other techniques.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussioncontrasting

confidence: 59%

Longitudinal Speech and Fistula Outcomes Following Primary Cleft Palate Repair at a Single Institution

Phillips,

Galarza,

Sink

et al. 2024

Ann Plast Surg

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“…Patient's developmental age at the time of repair (coded ToR) was the only other variable that showed significant positive correlation to the occurrence of ONF in this study. Although this observation has been contradicted by a recent study [26] which observed that timing of surgery made no difference to fistula development, the authors' observation arose from a dichotomy of patients into age groups < 4 years vs >4 years. This categorisation is at variance with what we did in this study whereby patients were grouped by their developmental milestones into infant, toddler, preschooler, school age and adolescents.…”

Section: Discussionmentioning

confidence: 74%

Predictors of fistula formation after primary palatoplasty

Yarhere,

Akadiri,

Akinbami

et al. 2024

J Oral Med Oral Surg

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Background: The goal of cleft palate repair is to create a seal between the oral and nasal cavities while improving speech by creating a functional velum. Various surgical techniques are at the surgeon's disposal to achieve this. Unfortunately, this sometimes fails, leading to formation of oronasal fistula. Objective: This study aimed to determine the predictors of oronasal fistula (ONF) formation following primary cleft palate repair. Methodology: This prospective interventional study involved cleft palate patients recruited from the University of Port Harcourt Teaching Hospital. Basic demographics and clinical data of participants were recorded preoperatively while morphometric measurements were taken under general anaesthesia to determine Cleft Palate Index and Cleft width. Four surgeons performed the procedures, and three surgical techniques were employed. Participants were followed up for a mean period of 5 months. The occurrence, location, and fate of ONF were documented. Correlation between ONF and potential predictor variables was tested, and determinant(s) of fistula formation was explored. Data was analysed using IBM SPSS version 21.0 with statistical significance set at P < 0.05. Result: Eighty-two participants with ages ranging from 9 months to 19 years completed the study. The initial incidence of ONF was 29.3% but 16.7% of these cases resolved spontaneously within 5 weeks. Cleft Palate Index, Cleft width, and time (age) of repair significantly correlated with occurrence of ONF. However, Cleft width was the only statistically significant (p = 0.049) individual determinant of fistula formation. Conclusion: In this study, Cleft width W is the most important predictor of ONF formation.

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The effect of collagen matrix graft on palatal fistula formation after cleft palate repair: A preliminary randomized controlled study

Egbunah,

Zhu,

Hauri

et al. 2024

Journal of Cleft Lip Palate and Craniofacial Anomalies

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Objective: The objective of this study was to compare the incidence of palatal fistula formation between cleft palate (CP) repair with collagen matrix graft and conventional repair without collagen matrix graft. Patients and Methods: This was a preliminary randomized controlled study of patients with CP who underwent primary palatoplasty (two-flap palatoplasty technique) at the Lagos University Teaching Hospital. Patients were randomly allocated to either the test group (palatoplasty with collagen graft) or the control group (palatoplasty without collagen graft). The primary outcome was palatal fistula, and secondary outcomes were wound dehiscence, surgical site inflammation, surgical site infection, and surgeon satisfaction up to 3 months postoperative (PO). Results: Ten patients were recruited, five in each group. Only one patient in the control group developed a palatal fistula at 1 month PO on the soft palate which extended to the junction of hard and soft palate at 3 months PO. Eight patients developed wound dehiscence, five in the test group and three in the control group. Surgical site inflammation persisted up to at least 7 days PO in nine patients (five in the test group and four in the control group). All persistent wound dehiscence and surgical site inflammation resolved at 3 months PO. No patient developed surgical site infection. No significant difference was seen between the study group and wound dehiscence, surgery time, and difficulty of the procedure (P > 0.05 for all associations). Conclusion: Collagen graft may have a protective effect against fistula formation without significantly increasing surgery time and difficulty. However, due to the small sample size, the study failed to draw definite conclusions. Results from this study may inform future designs of larger randomized controlled studies.

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

Cited by 3 publications

References 29 publications

Longitudinal Speech and Fistula Outcomes Following Primary Cleft Palate Repair at a Single Institution

Longitudinal Speech and Fistula Outcomes Following Primary Cleft Palate Repair at a Single Institution

Predictors of fistula formation after primary palatoplasty

The effect of collagen matrix graft on palatal fistula formation after cleft palate repair: A preliminary randomized controlled study

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