Cleft Palate Repair: Description of an Approach, Its Evolution, and Analysis of Postoperative Fistulas. Issue 5 (May 2018)

• Record Type: Journal Article
• Authors: Tse, Raymond W.; Siebold, Babette
• Is Part Of: Plastic and reconstructive surgery. Volume 141:Issue 5(2018:May)
• Publication Date: 2018-05
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000004324
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Fistulas following cleft palate repair impair speech, health, and hygiene and occur in up to 35 percent of cases. The authors detail the evolution of a surgical approach to palatoplasty; assess the rates, causes, and predictive factors of fistulas; and examine the temporal association of modifications to fistula rates. Methods: Consecutive patients ( n = 146) undergoing palatoplasty during the first 6 years of practice were included. The technique of repair was based on cleft type, and a common surgical approach was used for all repairs. Results: The fistula rate was 2.4 percent ( n = 125) after primary repair and 0 percent ( n = 21) after secondary repair. All complications occurred in patients with type III or IV clefts. Cleft width and cleft-to–total palatal width ratio were associated with fistulas, whereas syndromes, age, and adoption were not. Most complications could also be attributed to technical factors. During the first 2 years, modifications were made around specific anatomical features, including periarticular bony hillocks, maxillopalatine suture, velopalatine pits, and tensor insertion. The fistula rate declined by one-half in subsequent years. Conclusions: The authors describe a surgical approach to cleft palate repair, its evolution, and surgically relevant anatomy. Fistulas were associated with increasing cleft severity but could also be attributed to technical factors. A reduction in frequency and severity of fistulas was consistent with a learning curve and may in part be associated with modifications to the surgical approach. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Abstract : Supplemental Digital Content is available in the text.