On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair

2019 ◽  
Vol 56 (10) ◽  
pp. 1302-1313
Author(s):  
Ana Tache ◽  
Maurice Y. Mommaerts
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
Oronasal Fistula ◽  
Type Iv ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Fistula Rate

Objective: The aims of the study were to assess the postoperative oronasal fistula rate after 1-stage and 2-stage cleft palate repair and identify risk factors associated with its development. Design: Systematic review. Setting: Various primary cleft and craniofacial centers in the world. Patients, Participants: Syndromic and nonsyndromic cleft lip, alveolus, and palate patients who had undergone primary cleft palate surgery. Intervention: Assessment of oronasal fistula frequency and correlation with staging, timing, and technique of repair, gender, and Veau type. The results obtained in this systematic review were compared with those in previous reports. Outcome: The main outcome is represented by the occurrence of the oronasal fistula after 1-stage versus 2-stage palatoplasty. Results: The mean fistula percentage was 9.94%. In the Veau I, II, III, and IV groups, the respective fistula rates were 2%, 7.3%, 8.3%, and 12.5%. Oronasal fistula locations based on the Pittsburgh Fistula Classification System were soft palate (type II), 16.2%; soft palate–hard palate junction (type III), 29.3%; and hard palate (type IV), 37.3%. There were no statistically significant differences between 1-stage and 2-stage palatoplasty, syndromic and nonsyndromic, or male and female patients. Primary palatoplasty timing was not a significant predictor. Conclusion: Some disparities arose when comparing studies, mainly regarding location and types of clefting prone to oronasal fistulation. Interestingly, the fistula rate does not differ between 1- and 2-stage closure, and timing of the repair does not play a role.

scholarly journals Cleft palate repair and variations

2009 ◽  
Vol 42 (S 01) ◽  
pp. S102-S109
Author(s):  
Karoon Agrawal
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Cleft Lip ◽  
The Face ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Pharyngeal Flap ◽  
The One ◽  
Ideal Technique

ABSTRACTCleft palate affects almost every function of the face except vision. Today a child born with cleft palate with or without cleft lip should not be considered as unfortunate, because surgical repair of cleft palate has reached a highly satisfactory level. However for an average cleft surgeon palatoplasty remains an enigma. The surgery differs from centre to centre and surgeon to surgeon. However there is general agreement that palatoplasty (soft palate at least) should be performed between 6-12 months of age. Basically there are three groups of palatoplasty techniques. One is for hard palate repair, second for soft palate repair and the third based on the surgical schedule. Hard palate repair techniques are Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, Aleveolar extension palatoplasty, vomer flap, raw area free palatoplasty etc. The soft palate techniques are intravelar veloplasty, double opposing Z-plasty, radical muscle dissection, primary pharyngeal flap etc. And the protocol based techniques are Schweckendiek's, Malek's, whole in one, modified schedule with palatoplasty before lip repair etc. One should also know the effect of each technique on maxillofacial growth and speech. The ideal technique of palatoplasty is the one which gives perfect speech without affecting the maxillofacial growth and hearing. The techniques are still evolving because we are yet to design an ideal one. It is always good to know all the techniques and variations so that one can choose whichever gives the best result in one's hands. A large number of techniques are available in literature, and also every surgeon incorporates his own modification to make it a variation. However there are some basic techniques, which are described in details which are used in various centres. Some of the important variations are also described.

Cleft Palate Repair Using a Marginal Musculo-Mucosal Flap

2006 ◽  
Vol 43 (6) ◽  
pp. 651-655 ◽  
Author(s):  
Hisao Ogata ◽  
Tatsuo Nakajima ◽  
Fumio Onishi ◽  
Ikkei Tamada ◽  
Makoto Hikosaka
Keyword(s):  
Cleft Palate ◽  
Soft Palate ◽  
Hard Palate ◽  
Primary Repair ◽  
Formation Rate ◽  
Fistula Formation ◽  
Mucosal Flap ◽  
Periosteal Flap ◽  
Oronasal Fistula ◽  
Palate Repair

Objective: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. Methods: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. Results: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. Conclusions: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non–push-back method of hard palate repair.

Oronasal Fistula Incidence Associated With Vomer Flap Repair of Cleft Palate: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 105566562097456
Author(s):  
Katherine Vandenberg ◽  
Michael Castle ◽  
Fares Qeadan ◽  
Tania Kraai
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Meta Analysis ◽  
Random Effect ◽  
Oronasal Fistula ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Syndromic Diagnosis ◽  
Palate Repair ◽  
Vomer Flap

Objectives: To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. Design: A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: “vomer flap” and “cleft palate repair” were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. Main Outcome Measure(s): Incidence of ONFs. Results: The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. Conclusions: The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.

scholarly journals Oronasal fistula in cleft palate surgery

2009 ◽  
Vol 42 (S 01) ◽  
pp. S123-S128 ◽  
Author(s):  
Partha Sadhu
Keyword(s):  
Cleft Palate ◽  
Recurrence Rate ◽  
Surgical Procedures ◽  
Soft Palate ◽  
Hard Palate ◽  
Local Flaps ◽  
Oronasal Fistula ◽  
Palate Repair ◽  
Vascular Accidents ◽  
Nasal Regurgitation

ABSTRACTOronasal fistula (ONF) is the commonest complication associated with cleft palate surgery. The main symptoms associated with ONF are nasal regurgitation of food matter and hypernasality of voice. Repair of cleft palate under tension is considered to be the main reason of ONF though vascular accidents and infection can also be the cause. Most of the ONFs are situated in the hard palate or at the junction of hard and soft palate. Repair of ONF depends on its site, size and mode of presentation. A whole spectrum of surgical procedures starting from small local flaps to microvascular tissue transfers have been employed for closure of ONF. Recurrence rate of ONF is 25% on an average after the first attempt of repair.

scholarly journals Non-Interventional Factors Influencing Velopharyngeal Function For Speech In Initial Cleft Palate Repair: A Systematic Review Protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
David Sainsbury ◽  
◽  
Caroline Williams ◽  
Catherine de Blacam ◽  
Joanne Mullen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Screening Tool ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Velopharyngeal Insufficiency ◽  
Future Studies ◽  
Cleft Palate Repair ◽  
Palate Repair

Abstract Background This systematic review aims to inform the development of a screening tool which pre-operatively predicts which children are likely to develop velopharyngeal insufficiency, one of the causes of poor speech outcomes, following cleft palate repair. This would be highly beneficial as it would inform pre-operative counselling of parents, allow targeted speech and language therapy, and enable meaningful comparison of outcomes between surgeons, techniques, and institutions. Currently, it is unclear which factors influence speech outcomes. A systematic review investigating the non-interventional factors which potentially influence speech outcomes following cleft palate repair is warranted. This may be illuminating in itself or provide foundations for future studies. Methods A systematic review will be carried out according to Cochrane methodology and reported according to PRISMA guidelines (PLoS Med 6: e1000097, 2009). Systematic review software will be used to facilitate three-stage screening by two independent reviewers experienced in cleft lip and palate. Thereafter, data extraction and GRADE assessment will be performed in duplicate by five independent reviewers experienced in cleft lip and palate. Studies reporting the proportion of patients who were recommended or underwent secondary speech surgery for velopharyngeal insufficiency following primary surgery for cleft palate will be included. The study findings will be tabulated and summarised. The primary outcome measure will be further speech surgery (either recommended or performed). The secondary outcome measure will be perceptual speech assessment for the presence of velopharyngeal insufficiency. A meta-analysis is planned. However, if this is not possible, due to the anticipated marked heterogeneity of study characteristics, pre-operative assessment, and the recorded outcome measures, a narrative synthesis will be undertaken. Discussion This systematic review may provide sufficient data to inform the development of a screening tool to predict the risk of velopharyngeal insufficiency prior to cleft palate repair. However, it is anticipated that these findings will provide the foundation for future studies in this area. Systematic review registration Registered on 19 December 2016 with PROSPERO CRD42017051624

scholarly journals Speech Outcome Analysis after Primary Cleft Palate Repair: Interim Siriraj Hospital Audit

2021 ◽  
Vol 73 (11) ◽  
pp. 744-751
Author(s):  
Sunisa Thongprayoon ◽  
Kanokwan Liadprathom ◽  
Apirag Chuangsuwanich ◽  
Mark H. Moore ◽  
Sarut Chaisrisawadisuk
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Outcome Analysis ◽  
Oronasal Fistula ◽  
Primary Surgery ◽  
Articulation Disorder ◽  
Velopharyngeal Incompetence ◽  
Cleft Palate Repair ◽  
Siriraj Hospital ◽  
Palate Repair

Objective: To evaluate the speech outcomes after primary cleft palate repair in a single tertiary medical institution of Thailand.Materials and Methods: A prospective cohort study was performed. Patients who had cleft palate with/without cleft lip and underwent primary cleft palate repair were included. Speech assessment was performed using the Pittsburgh weighted speech score (PWSS) by a speech-language pathologist.Results: Forty patients (21 males and 19 females) who underwent primary cleft palate repair at Siriraj Hospital were included. The median age at the time of speech evaluation was 7 years. The median age at primary cleft palate surgery was 12 months. The predominant cleft palate type was Veau 3 (47.5%). Oronasal fistula occurred 40%. Two-flap palatoplasty and intravelar veloplasty were the most common procedures. Median PWSS was 7, in which the competence velopharyngeal mechanism was found 5%, borderline competence 10%, borderline incompetence 32.5%, and incompetence velopharyngeal mechanism 52.5%. Among the velopharyngeal incompetence group, articulation disorder was the most common disorder with median score of 3. Besides, the median scores for hypo/hyper-nasality, nasal emission, phonation, and facial grimace disorder were 1, 2, 0 and 0, respectively. There was no statistically significant association between velopharyngeal incompetence and cleft types, age at primary surgery, type of operation, the width of cleft palate and prevalence of postoperative oronasal fistula or otitis media effusion.Conclusion: Velopharyngeal incompetence has been commonly identified after cleft palate repair in our institute. The articulation disorder is the most common characteristic.

Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

2021 ◽  
Vol 58 (5) ◽  
pp. 603-611
Author(s):  
Giap H. Vu ◽  
Christopher L. Kalmar ◽  
Carrie E. Zimmerman ◽  
Laura S. Humphries ◽  
Jordan W. Swanson ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measure ◽  
Charge Ratio ◽  
Fistula Repair ◽  
Case Volume ◽  
Secondary Surgery ◽  
Hospital Case ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

Repair of Recurrent Cleft Palate with Free Vastus Lateralis Muscle Flap

2012 ◽  
Vol 49 (2) ◽  
pp. 245-248 ◽  
Author(s):  
Jose G. Christiano ◽  
Amir H. Dorafshar ◽  
Eduardo D. Rodriguez ◽  
Richard J. Redett
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Vastus Lateralis ◽  
Muscle Flap ◽  
Free Flaps ◽  
Vastus Lateralis Muscle ◽  
Oronasal Fistula ◽  
Lateralis Muscle ◽  
Palate Repair

A 6-year-old girl presented with a large recalcitrant oronasal fistula after bilateral cleft lip and palate repair and numerous secondary attempts at fistula closure. Incomplete palmar arches precluded a free radial forearm flap. A free vastus lateralis muscle flap was successfully transferred. No fistula recurrence was observed at 18 months. There was no perceived thigh weakness. The surgical scar healed inconspicuously. Free flaps should no longer be considered the last resort for treatment of recalcitrant fistulas after cleft palate repair. A free vastus lateralis muscle flap is an excellent alternative, and possibly a superior option, to other previously described free flaps.

Impact of cleft palate repair on speech and development of dentoalveolar deformities

2021 ◽  
Vol 16 (3) ◽  
pp. 47-53
Author(s):  
Yu.V. Stebeleva ◽  
◽  
Ad.A. Mamedov ◽  
Yu.O. Volkov ◽  
A.B. McLennan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Normal Functioning ◽  
Primary Surgery ◽  
Cleft Palate Repair ◽  
Congenital Cleft ◽  
Palate Repair ◽  
Late Postoperative Period

Surgical repair of cleft palate is quite difficult because it aims not only to eliminate the anatomical defect of the palate, but also to ensure normal functioning, including speech. Moreover, successful surgery implies no or minimal deformation of the middle face that can be corrected in the late postoperative period. No doubt that primary surgery (both in terms of technique and time) is crucial for further growth and development of the maxilla. However, surgical techniques and the age of primary cleft palate repair vary between different clinics, which makes this literature review highly relevant. Key words: cleft palate repair, cleft palate, congenital cleft lip and palate

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