Effects of phenytoin spray in prevention of fistula formation following cleft palate repair

2019 ◽  
Vol 47 (12) ◽  
pp. 1887-1890
Author(s):  
Shahin Abdollahi Fakhim ◽  
Masoud Nouri-Vaskeh ◽  
Mohamad Amin Fakhriniya
Keyword(s):  
Cleft Palate ◽  
Fistula Formation ◽  
Cleft Palate Repair ◽  
Palate Repair

Throat Swabs Taken on the Operating Table Prior to Cleft Palate Repair and Their Relevance to Outcome: A Prospective Study

2009 ◽  
Vol 46 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Andrew Rennie ◽  
Linda J. Treharne ◽  
Bruce Richard
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Cleft Palate ◽  
Fistula Formation ◽  
Operating Table ◽  
Upper Respiratory Tract ◽  
Operating Microscope ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Upper Respiratory

Objective: The main objective of this study was to determine whether bacteria cultured from oral swabs taken at the time of surgery predicted postoperative fistula formation. Design: The study was a prospective longitudinal audit. Setting: The setting was a designated U.K. N.H.S. cleft center. Patients: Subjects consisted of the patients of a single cleft surgeon who were undergoing surgery for cleft palate repair or cleft fistula repair. Interventions: Oral microbiological swabs were taken from patients while they were on the operating table just before surgery. Main outcome measures: The results from microbiological culture of the swabs were recorded, as was the presence or absence of a fistula at 6 months postoperatively. Additional collected information was related to the severity of the cleft, whether the operating microscope was used during surgery, and whether the patient had developed a postoperative upper respiratory tract infection. Results: Positive swab cultures were not significantly associated with fistula formation. Use of the operating microscope was not associated with an increase or decrease in the number of fistulas. A fistula developed in all patients who experienced a postoperative upper respiratory tract infection. Conclusions: The practice of performing routine preoperative mouth swabs should be abandoned because the presence of bacteria in the mouth does not increase the risk of fistula formation.

scholarly journals Incidence of Palatal Fistula after One-Stage Palatoplasty and Factors Influencing the Fistula Occurrence

1970 ◽  
Vol 2 (4) ◽  
Author(s):  
Nurardhilah Vityadewi ◽  
Kristaninta Bangun
Keyword(s):  
Body Weight ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Fistula Formation ◽  
Bivariate Analysis ◽  
One Stage ◽  
Cleft Palate Repair ◽  
Hypernasal Speech ◽  
Palate Repair

Background: Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas are related to an increased rate of hypernasal speech, articulation problems, and food or liquid regurgitation from the nose. Fistulas also tend to recur after a secondary repair to address the fistulas. This study reviews the rate of fistula in our craniofacial center after a onestage cleft palate repair; and to determine whether, cleft type, age at repair, type of cleft repair, hemoglobin level presurgery, and patients nutritional state influence the risk of fistula occurence. Patient and Method: A retrospective analysis was performed on medical records of 93 patients who underwent palate repair between January 2012 to October 2013. All consecutive cleft (lip and) palate patients are included. Bivariate analysis was performed to identify the predictors of fistula formation. Result: Ninety-three patients (50 male and 43 female) underwent one-stage palatoplasty. Cleft palate fistulas occured in 19 of 93 patients (20,4%). The age of the patients at the time of repair ranged from 9 to 144 months (mode 18 months). All palate repairs were done in one stage, using either the two flap (N=66), Wardill-Kilner (N=24), Furlow (N=2), and Langenback (N=1) techniques. No significant influence was found related between age at the time of repair (p 0.789), body weight (p 0.725), Hemoglobin value (p 0.295), and type of cleft (p 0.249) to the rate of fistula occurrence. Summary: This study found no association between , body weight, preoperative hemoglobin value, and the type of cleft to the rate of fistula following cleft palate surgery.

A Salvage Procedure in Cleft Palate Repair: Suturing Nasal Mucosa Directly to Palatine Process

2007 ◽  
Vol 44 (3) ◽  
pp. 233-234 ◽  
Author(s):  
Gökhan Tunçbilek ◽  
Ersoy Konaş ◽  
Figen Özgür
Keyword(s):  
Cleft Palate ◽  
Nasal Mucosa ◽  
Fistula Formation ◽  
Salvage Procedure ◽  
Time Saving ◽  
Additional Surgery ◽  
Mucoperiosteal Flap ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Palatine Bone

Objective: Palatal fistulas are among the complications of cleft palate repair requiring additional surgery. Suturing the nasal mucosa and mucoperiosteal flaps together in a tension-free manner to create a double-layered closure in the hard palate is one of the most important points in prevention of dehiscence and fistula formation. In this report, we describe a salvage procedure to repair nasal mucosa that might be lacerated while being freed from the upper surface of the palatal process. Method: To restore the nasal lining, an ipsilateral vomer mucoperiosteal flap or the opposite nasal mucosa flap is advanced to the palatine bone and sutured directly to the palatal process in order to guarantee an intact cleft palate repair. Results: This method is an easy, simple, and time-saving procedure. It should be a useful addition to the armamentarium of every plastic surgeon, especially those working as consultants in training units.

Reinforcing the Modified Double-Opposing Z-Plasty Approach Using the Pedicled Buccal Fat Flap as an Interpositional Layer for Cleft Palate Repair

2021 ◽  
pp. 105566562110647
Author(s):  
Rafael Denadai ◽  
Pang-Yun Chou ◽  
Lun-Jou Lo
Keyword(s):  
Cleft Palate ◽  
Middle Layer ◽  
Fistula Formation ◽  
Growth Disturbance ◽  
Full Coverage ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Single Intervention ◽  
Palate Repair ◽  
Relaxing Incisions

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation.

Clinical Outcomes of the Furlow Z-Plasty for Primary Cleft Palate Repair

2008 ◽  
Vol 45 (5) ◽  
pp. 501-510 ◽  
Author(s):  
Rohit K. Khosla ◽  
Kelly Mabry ◽  
Charles L. Castiglione
Keyword(s):  
Cleft Palate ◽  
Clinical Outcomes ◽  
Velopharyngeal Insufficiency ◽  
Fistula Formation ◽  
Pierre Robin Sequence ◽  
Robin Sequence ◽  
Surgeon Experience ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Pierre Robin

Objective: To review the clinical outcomes following the Furlow Z-plasty for primary cleft palate repair. The primary objective was to determine if the presence of an associated sequence or syndrome (i.e., Pierre Robin sequence), age at palate repair, cleft type, or surgeon experience influenced speech outcomes after a Furlow Z-plasty. Design: The outcomes of 140 patients who underwent palate repair were analyzed retrospectively. Speech evaluations were performed to score the severity of hypernasality, nasal escape, articulation errors, and velopharyngeal insufficiency. Results: The mean age at latest evaluation was 4 years 9 months (age range 2 years old to 12 years old and 4 months). Of the 140 patients, 83% had no evidence of hypernasality, 91% had no presence of nasal escape, and 69% had no articulation errors. Overall, 84% of patients had no evidence of velopharyngeal insufficiency. Secondary posterior pharyngeal flap to correct velopharyngeal insufficiency was required in only 2.1% of patients. The formation of an oronasal fistula occurred in only 3.6% of patients. Nonsyndromic patients with Pierre Robin sequence and syndromic patients did just as well as purely nonsyndromic patients in terms of velopharyngeal insufficiency, hypernasality, and nasal escape. Syndromic patients were more likely to make mild-to-moderate articulation errors. In addition, age at palate repair, cleft type, and surgeon experience had no statistically significant effect on speech results. Conclusions: The Furlow Z-plasty yielded excellent speech results in our patient population with minimal and acceptable rates of fistula formation, velopharyngeal insufficiency, and the need for additional corrective surgery.

scholarly journals Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

2013 ◽  
Vol 59 (6) ◽  
pp. 302-305 ◽  
Author(s):  
Stoicescu Simona ◽  
Enescu Dm
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Fistula Formation ◽  
Two Stage ◽  
One Stage ◽  
Age At Surgery ◽  
Cleft Palate Repair ◽  
Palate Repair

Abstract Introduction: Although cleft lip and palate (CLP) is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation) cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of oronasal fistula rate. Material and methods: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair over a five-year period, from 2008 to 2012. All cleft palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, one- or two-stage cleft palate repair were collected and analyzed. Results: Fifty-three (66%) and twenty-seven (34%) patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, associating cleft lip to cleft palate. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%. Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the protocol of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery)

scholarly journals Effect of collagen matrix on postoperative palatal fistula in cleft palate repair

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jeong Hyun Ha ◽  
Yeonwoo Jeong ◽  
Youn Taek Koo ◽  
Sungmi Jeon ◽  
Jeehyeok Chung ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Characteristic Curve ◽  
Collagen Matrix ◽  
Fistula Formation ◽  
Collagen Membrane ◽  
Palatal Fistula ◽  
Postoperative Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Collagen Graft

Abstract Palatal fistula is a challenging complication following cleft palate repair. We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow’s double opposing z-plasty) in Seoul National University Children’s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18 months) were analyzed. The average cleft width was 7.0 mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9/244). Palatal ratio (p = 0.014) and cleft width (p = 0.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25 mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0/5, 1/6 (16.7%), and 4/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.

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