Revision Surgery of the Cleft Palate

Hu, Shirley; Levinson, Jared; Rousso, Joseph J.

doi:10.1055/s-0040-1709429

Cited by 14 publications

(7 citation statements)

References 78 publications

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“…However, the focus with secondary palate repair is more functional, aiming to address either VPI or oronasal fistula. 26 Our subgroup analysis revealed that only 9.4% of those undergoing secondary palatoplasty were documented to address VPI. It is important to note that this percentage is likely an underestimation, as only 47% of patients in the VPI cohort had an ICD 9 or ICD 10 code indicating VPI.…”

Section: Discussionmentioning

confidence: 79%

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The Life Cycle of Orofacial Cleft Operations

Koh,

Gong,

Sobti

et al. 2023

Journal of Craniofacial Surgery

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Patients with cleft lip and palate must undergo various surgical interventions at appropriate times to achieve optimal outcomes. While guidelines for the timing of these operations are well known, it has not yet been described if national surgical practice reflects these recommendations. This study evaluates whether orofacial operations are performed in time frames that align with advised timing. Time-to-event analyses were performed using the 2012–2020 Pediatric National Surgical Quality Improvement Program database on the ages at time of orofacial operations. Outliers with an absolute Z-score of 3.29 or greater were excluded. Cleft lip (N=9374) and palate (N=13,735) repairs occurred earliest at mean ages of 200.99±251.12 and 655.08±694.43 days, respectively. Both operations clustered along the later end of recommended timing. 69.0% of lip versus 65.1% of palate repairs were completed within the advised age periods. Cleft lip (N=2850) and palate (N=1641) revisions occurred at a mean age of 7.73±5.02 and 7.00±4.63 years, respectively. Velopharyngeal insufficiency operations (N=3026), not including palate revision, were performed at a delayed mean age of 7.58±3.98 years, with only 27.7% of operations occurring within the recommended time frame. Finally, 75.8% of alveolar bone grafting cases (N=5481) were found to happen within the advised time period, with a mean age of 10.23±2.63 years. This study suggests that, with the exception of VPI procedures, orofacial operations reliably cluster near their recommended age periods. Nevertheless, primary lip repair, palatoplasty, and velopharyngeal insufficiency procedures had a mean age that was delayed based on advised timing.

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Section: Discussionmentioning

confidence: 79%

“…Patients undergoing palate repair may also require a secondary revision operation. However, the focus with secondary palate repair is more functional, aiming to address either VPI or oronasal fistula 26 . Our subgroup analysis revealed that only 9.4% of those undergoing secondary palatoplasty were documented to address VPI.…”

Section: Discussionmentioning

confidence: 87%

The Life Cycle of Orofacial Cleft Operations

Koh,

Gong,

Sobti

et al. 2023

Journal of Craniofacial Surgery

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Section: Figurementioning

confidence: 99%

“…The choice of the surgical technique is mainly made based on the location and size [ 14 , 15 , 16 ]. Hu et al describe a very detailed decision tree ( Figure 2 ) based on the Pittsburg classification ( Figure 1 ) [ 17 ]. The timing and the choice of the surgical technique allow an increase in the success rate in closing the palatal fistulae [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Novel Technique for Closure of Small Palatal Fistula

Brauner

Piccoli

Sallemi

et al. 2022

JPM

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A palatal fistula is a pathological condition that connects the nasal cavities with the oral cavity. An oral–nasal fistula is reported as a possible post-surgical complication after the removal of oral carcinomas. The presence of a palatal fistula affects the patient’s quality of life, making it necessary to apply a prosthetic device, such as a palatal plate, to keep the nasal cavities separated from the oral one. There are several surgical techniques to close a palatal fistula, but it is not possible to define the optimal technique as the approach is extremely dependent on the characteristics of the fistula. The aim of this article is to propose a minimally invasive technique to reduce the size of palatal fistulae and to reduce the surgical difficulty (NSPF). A total of 20 patients fulfilled the inclusion criteria and were checked every two weeks. The fistula was injured with a needle every 2 weeks. Fifteen patients who healed with complete closure of the fistula reported no need for a palatal protection plate to eat, drink and speak normally. It is possible to conclude that the NSPF protocol is a valid approach for the non-surgical reduction of palatal fistulae, and it is possible, when the appropriate conditions are present, to achieve complete closure.

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“…Palatal wound healing happened after cleft palate repair and trauma and tumor excision ( Majid, 2008 ; Sahoo et al, 2016 ; Alonso et al, 2019 ). Poor palatal wound healing could lead to oronasal fistula (ONF), resulting from extensive tension, infection, or hematoma ( Hu and Rousso Joseph, 2020 ; Pollard et al, 2020 ). Oronasal fistula (ONF) was a common complication after cleft palate repair, which manifested as abnormal communication between oral and nasal cavities ranging from the alveolar process to the uvula ( Honnebier et al, 2000 ; Mahajan et al, 2018 ; Alonso et al, 2019 ; Pollard et al, 2020 ), which could cause food reflux, unclear pronunciation and impaired velopharyngeal function, which affected the patient’s quality of life ( Mahajan et al, 2018 ; Garg et al, 2019 ; Huang et al, 2023b ).…”

Section: Introductionmentioning

confidence: 99%

Current insights in the preclinical study of palatal wound healing and oronasal fistula after cleft palate repair

Chen,

Yang,

Yin

et al. 2023

Front. Cell Dev. Biol.

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Poor palatal wound healing after cleft palate repair could lead to unfavorable prognosis such as oronasal fistula (ONF), which might affect the patient’s velopharyngeal function as well as their quality of life. Thus, restoring poor palatal wound healing for avoiding the occurrence of ONF should be considered the key to postoperative care after cleft palate repair. This review provided current insights in the preclinical study of poor palatal wound healing after cleft palate repair. This review comprehensively introduced the animal model establishment for palatal wound healing and related ONF, including the models by mice, rats, piglets, and dogs, and then demonstrated the aspects for investigating poor palatal wound healing and related treatments, including possible signaling pathways that could be involved in the formation of poor palatal wound healing, the related microbiota changes because of the deformity of palatal structure, and the studies for potential therapeutic strategies for palatal wound healing and ONF. The purpose of this review was to show the state of the art in preclinical studies about palatal wound healing after cleft palate repair and to show the promising aspects for better management of palatal wound healing.

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Revision Surgery of the Cleft Palate

Cited by 14 publications

References 78 publications

The Life Cycle of Orofacial Cleft Operations

The Life Cycle of Orofacial Cleft Operations

Evaluation of a Novel Technique for Closure of Small Palatal Fistula

Current insights in the preclinical study of palatal wound healing and oronasal fistula after cleft palate repair

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