Risk of Persistent Palatal Fistula in Patients With Cleft Palate

Abstract

IMPORTANCE Many individuals with a cleft palate also have an associated craniofacial syndrome or anomaly.OBJECTIVE To investigate the predictive associations of persistent palatal fistulas in patients with previously repaired cleft palate. DESIGN, SETTING, AND PARTICIPANTSWe performed a case-control study of patients with cleft palate repairs from January 1, 1986, through December 31, 2000, at a major tertiary care hospital center in the Bronx, New York. The study population consisted of patients who had their primary surgery before the age of 3 years and had all their cleft-related treatment completed at the same hospital center. Palatal fistula was defined as a breakdown of the primary surgical repair of the palate, resulting in persistent patency between the oral and nasal cavities. Data collection was conducted by using the hospital centers' electronic medical records and patient tracking systems and confirmed by review of hard copies of patient records. MAIN OUTCOMES AND MEASURESThe Veau classification system was used to classify the preoperative cleft severity.RESULTS A total of 130 patients were identified-23 patients with palatal fistula and 107 controls. A total of 12 girls and 11 boys were identified in the palatal fistula group and 56 girls and 51 boys in the control group. The mean patient age at the time of palatoplasty was 12.6 and 14.5 months in the palatal fistula and control groups, respectively. A statistically significant association was found between the outcome of fistula and severity of cleft, as defined by the Veau classification system (P = .01). Furthermore, for each Veau class increase, the odds of a palatal fistula increased by 2.64 (95% CI, 1.35-5.13; P = .004). No statistically significant associations were found between the outcome of fistula and the following independent variables: patient sex (P = .98), patient age at palatoplasty (P = .82), type of palatoplasty (P = .57), surgeon (P = .15), orthodontic treatment (P = .59), ear infection (P = .30), or clefts associated with syndromes (P = .96). CONCLUSIONS AND RELEVANCEPalatal fistulas are reliably associated with severity of cleft, as defined by the Veau classification system. This knowledge gives the health care professional a more reliable method of preoperatively assessing the risk of postoperative palatal fistula in the cleft palate population.LEVEL OF EVIDENCE 3.

Implement of Palatoplasty Enhanced Recovery (PER) pathway for cleft palate repair after the audit from the Surgical Outcomes Monitoring and Improvement Program (SOMIP)

“…20,21 There was no statistical difference between the two groups. The study period started from 2008, which was correlated with the timing of data recruitment of the first SOMIP report.…”

“…Age, type of cleft palate and the presence of associated syndrome were reported to have influence on the surgical outcome. 20,21 There was no statistical difference between the two groups. One of the confounding factors was the number of surgeons involved.…”

Fístula após palatoplastia primária de acordo com a cirurgia plástica e fonaudiologia

“…Projeto Flórida (ECR-PF) é conhecido por investigar longitudinalmente os resultados de fala e de crescimento facial após a palatoplastia primária em pacientes com fissura labiopalatina transforame unilateral (FTU) não sindrômica (WILLIAMS et al, 1998;WILLIAMS et al, 2011 (MUZAFFAR et al, 2001;BAPTISTA;SALGADO, PEREIRA, 2005;PHUA;de CHALAIN, 2008;PARWAZ et al, 2009;WILLIAMS et al, 2011;DESHPANDE et al, 2014;AHMED et al, 2015).…”

“…Neste trabalho foi necessário ampliar a classificação padrão ouro incluindo-se as categorias sem dado, incompleto e duvidosa, de forma a caracterizar-se a presença ou ausência de fístula e localização destas. Outros trabalhos na literatura também reportaram ausência de registros sobre ocorrência de fístula após a palatoplastia primária (DIAH et al, 2007;PHUA;de CHALAIN, 2008;PASSOS, 2011;EBERLINC;KOŽELJ, 2012;AHMED et al, 2015) e segundo o trabalho de Smith et al (2007), além da falta de registro também é grande a variabilidade dos aspectos documentados.…”

“…A caracterização das fístulas geralmente é feita a partir de descritores, como tamanho, local de ocorrência e sintomatologia clínica (COHEN et al, 1991;MUZAFFAR et al, 2001;BAPTISTA;SALGADO, PEREIRA, 2005;DIAH et al, 2007;SMITH et al, 2007;PHUA;de CHALAIN, 2008;MURTHY, 2011;PARWAZ et al, 2009;LANDHEER;BREUGEM, VAN DER MOLEN, 2010;PASSOS, 2011;EBERLINC;KOZELJ, 2012;RICHARDSON;AGNI, 2014;WINTERS et al, 2013;DESHPANDE et al, 2014;HARDWICKE;LANDINI, RICHARD, 2014;AHMED et al, 2015). Quanto ao tamanho, as fístulas já foram categorizadas na literatura em pequena (< 2mm), média…”