On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

Abstract

Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

Furlow Versus Straight Line Repair With Intravelar Veloplasty: A 7-Year Single Institution Experience with Fistula Formation

“…The lack of any substantial, observable descriptive relationship between fistula formation and gender in our study supports previous studies that have found no such association, echoing the notion that there is no biological difference between boys and girls for post-palatoplasty fistula formation. 6,7,29,30 Potential barriers to care, such as insurance payer status, have also been previously studied in association with primary cleft palate repair. A 2011 retrospective study by Abbott et al 31 examined almost 3000 patients who underwent primary cleft palate repair from 2003 to 2008, finding a significant delay in repair for patients who were publicly insured.…”

“…[15][16][17][18] Following both Furlow and straight line repairs, fistula formation has been reported to correlate with Veau classification. 4,6,7,9,11,19,20 Adoption status has also been previously associated with incidence of fistula formation. [21][22][23][24] The primary aim of this study is to determine the incidence of fistula formation between Furlow and straight line with IVVP primary palatoplasty procedures at our institution, and our secondary aim is to characterize how the rate of fistula formation varies based on cleft classification, adoption status, and other potential risk factors.…”

“…The presence of a fistula in the palate has a negative effect on speech development, potentially leading to hypernasality and articulation difficulty; fistulae are also associated with an increased risk of recurrent infection and regurgitation of food and liquids into the nasal cavity. 6,7 Numerous studies have analyzed the rate of post-primary palatoplasty fistula formation. To date, studies have found a high degree of variability in the incidence of fistula development after primary palatoplasty, ranging from 0% to 61%.…”

“…The presence of a fistula in the palate has a negative effect on speech development, potentially leading to hypernasality and articulation difficulty; fistulae are also associated with an increased risk of recurrent infection and regurgitation of food and liquids into the nasal cavity. 6,7…”

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

“…However, a 2015 meta‐analysis of 11 studies on fistula following cleft palate surgery found an association between Veau IV classification and fistula development to exist 25 . The recent systematic review referenced above also found that Veau IV clefts had the highest rate of postoperative fistula and that this was independent of sex, diagnosis of a syndrome, age at primary repair of cleft palate, or the surgical technique (single stage or two‐stage palatoplasty) utilized 22 . It is thought that the increased tension from repairing a bilateral complete cleft palate may explain this association 20 .…”