Oronasal Fistula Risk After Palate Repair

Abstract

Objective: To assess risk factors for oronasal fistula, including 2-stage palate repair. Design: Retrospective analysis. Setting: Tertiary children’s hospital. Patients: Patients with non-submucosal cleft palate whose entire cleft repair was completed at the study hospital between 2005 and 2013 with postsurgical follow-up. Interventions: Hierarchical binary logistic regression assessed predictive value of variables for fistula. Variables tested for inclusion were 2 stage repair, Veau classification, sex, age at surgery 1, age at surgery 2, surgeon volume, surgeon, insurance status, socioeconomic status, and syndrome. Variables were added to the model in order of significance and retained if significant at a .05 level. Main Outcome Measure: Postoperative fistula. Results: Of 584 palate repairs, 505 (87%) had follow-up, with an overall fistula rate of 10.1% (n = 51). Among single-stage repairs (n = 211), the fistula rate was 6.7%; it was 12.6% in 2-stage repairs (n = 294, P = .03). In the final model utilizing both single-stage and 2-stage patient data, significant predictors of fistula were 2-stage repair (odds ratio [OR]: 2.5, P = .012), surgeon volume, and surgeon. When examining only single-stage patients, higher surgeon volume was protective against fistula. In the model examining 2-stage patients, surgeon and age at hard palate repair were significant; older age at hard palate closure was protective for fistula, with an OR of 0.82 ( P = .046) for each additional 6 months in age at repair. Conclusions: Two-stage surgery, surgeon, and surgeon volume were significant predictors of fistula occurrence in all children, and older age at hard palate repair was protective in those with 2-stage repair.

Impact of Cleft Palate on Tongue-Based Upper Airway Obstruction in Pierre Robin Sequence: Implications for Mandibular Distraction Osteogenesis and Timing of Cleft Palate Repair

“…We observed a palatal fistula rate of 38% in our patient cohort and while the majority were asymptomatic, 14% nonetheless required operative repair. This rate is consistent with the oronasal fistula rates reported in the literature for both the PRS, [21][22][23][24][25][26] as well as the isolated CP patient populations, [27][28][29][30][31][32] and does not suggest that the MDO intervention makes the cleft more favorable morphologically for closure.…”

Palatoplasty Using Alveolar Ridge Incisions: A Novel Approach for Addressing Cleft Palate Deformities

“…The primary outcome of cleft palate repair lies in the achievement of velopharyngeal competence without fistula. [4][5][6][7][8][9][10][11][12][13][14] Of our 19 patients, one patient (with Veau classifications of III) had postoperative oronasal fistulas. The patient did not require further surgical intervention.…”

“…In all, the rates of VPI within our cohort were lower than those reported in the literature. [4][5][6][7][8][9][10][11][12][13][14] In fact, Sullivan et al conducted a 29-year analysis of patients undergoing palatoplasty, and found that of 449 patients, 85.1% had postoperative VPI. 5 The study also found significant correction between the incidence of VPI and increased Veau hierarchy and age at the time of palatoplasty.…”

Prevention and management of oronasal fistulas

“…Several factors have been associated with ONF development after primary repair of a cleft palate. Outcomes are dependent on the type and timing of surgical repair, age at repair, surgeon and surgeon's volume, Veau classification, and cleft width [4][5][6]. Though a two-staged repair is primarily performed to minimize the impact on maxillary growth [7], several studies have shown it to be a significant risk factor for fistula formation [5,6,8].…”