Closure of Palatal Fistula with a Local Mucoperiosteal Flap Lined with Buccal Mucosal Graft

2000 ◽  
Vol 37 (2) ◽  
pp. 127-129 ◽  
Author(s):  
M.B.O.M. Honnebier ◽  
D.S. Johnson ◽  
A.A. Parsa ◽  
A. Dorian ◽  
F.D. Parsa
Keyword(s):  
Standard Form ◽  
Senior Author ◽  
Fistula Formation ◽  
Fistula Repair ◽  
Suitable Alternative ◽  
Buccal Mucosal Graft ◽  
Nasal Side ◽  
Long Term Follow Up ◽  
Mucoperiosteal Flap ◽  
Cleft Palate Repair

Objective Oro-nasal fistula is a common complication of palatoplasty. Current methods for fistula repair utilize mucoperiosteal flaps or pedicled flaps. These procedures are often cumbersome and leave a raw nasal surface, which may increase the incidence of postoperative risks and problems. In addition, the recurrence rate of the fistula is as high as 34%. We propose a simple two-layer method of fistula repair to avoid recurrences. Design A standard mucoperiosteal flap is raised on the oral side. A buccal mucosal graft is harvested from the cheeks and sutured to the nasal side of the flap that is then inset into the fistula. Setting Patients were either referred to the senior author's private practice (four patients) or were patients who had previously been operated on by the senior author himself (three patients). Subjects Study subjects consisted of seven patients, four males and three females, ages 14 months to 8 years. All patients had previously undergone cleft palate repair, complicated by subsequent oro-nasal fistula formation. Interventions All patients underwent oro-nasal fistula repair under general anesthesia with a local mucoperiosteal flap lined with buccal mucosal grafts placed on the nasal side of the flap. Results In all cases, the fistula was completely closed at first attempt without complications. Patients were followed for a minimum of 2 years, without evidence of recurrence. Conclusions Our proposed surgical procedure for fistula closure using a standard mucoperiosteal flap lined with a buccal mucosal graft is a suitable alternative for the repair of postpalatoplasty oro-nasal fistulas. Further study and long-term follow-up is needed to establish this method as a new standard form of repair.

Modified Von Langenbeck Cleft Palate Repair Using an Anterior Triangular Flap: Decreased Incidence of Anterior Oronasal Fistulas

2009 ◽  
Vol 46 (3) ◽  
pp. 299-304 ◽  
Author(s):  
Tara Lynn Stewart ◽  
David M. Fisher ◽  
Jaret L. Olson
Keyword(s):  
Cleft Palate ◽  
Anterior Margin ◽  
Fistula Formation ◽  
Anterior Portion ◽  
Oronasal Fistula ◽  
Triangular Flap ◽  
Secondary Palate ◽  
Nasal Side ◽  
Cleft Palate Repair ◽  
Hypernasal Speech

Objective: A complication following cleft palate surgery is the development of oronasal fistulas. Despite recent advances aimed at addressing this concern, rates of postoperative fistulas have remained unchanged and are reported at between 3% and 60%. Oronasal fistulas commonly occur between the hard and soft palate and at the anterior portion of the cleft. These fistulas lead to functional problems with nasal emission, hypernasal speech, and food regurgitation through the nose. For clefts of the secondary palate, we developed a modification of the Von Langenbeck technique in which an anterior triangular flap is used to decrease the incidence of postoperative fistulas. Method: A triangular flap composed of oromucosa was designed for isolated clefts of the secondary palate only. It is based at the anterior margin of the cleft and is used as a turnover flap to allow closure of the often very tight anterior nasal side. A retrospective chart analysis was performed from 2000 to 2007. All patients who had isolated clefts of the secondary palate and had undergone a modified Von Langenbeck procedure were included in the study. Patients were evaluated 4 to 8 weeks postoperatively for the presence of oronasal fistulas. Results: With the introduction of the anterior triangular flap, we show that 0 of 182 patients developed a postoperative oronasal fistula. Conclusions: This modification of the standard Von Langenbeck uses an anterior triangular flap and confers the advantage of assisting in nasal side closure of the anterior margin of the cleft; in doing so, it reduces the rate of fistula formation.

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.

Palatal Measurements Pre- and Post-Furlow Cleft Palate Repair: Analysis of Palatal Lengthening and Comparison Within Cleft Types

2018 ◽  
Vol 56 (5) ◽  
pp. 601-609 ◽  
Author(s):  
Brian L. Chang ◽  
Jason W. Yu ◽  
Elena Nikonova ◽  
David W. Low ◽  
Jesse A. Taylor ◽  
...  
Keyword(s):  
Soft Palate ◽  
Tertiary Care ◽  
Fistula Formation ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Operating Surgeon

Objective: The purpose of this study was to characterize intraoperative palatal lengthening with the modified Furlow cleft palatal repair and to determine whether lengthening correlated with preoperative cleft width, cleft type, or operating surgeon. Design: Retrospective study. Setting: Academic tertiary care pediatric hospital. Patients: One hundred eighty pediatric patients undergoing primary or secondary palatoplasty using the Furlow technique. Interventions: Cleft and palatal lengths and widths were measured pre- and post-Furlow cleft palatal repair. Main Outcome Measures: Immediate postoperative percentage change in surface palate length, straight palate length, and soft palate length. Results: The average cleft widest width and width at the hard–soft palate junction were 10.2 and 9.5 mm, respectively, and varied with Veau cleft type. Following Furlow palatoplasty, lengths of the curved, straight, and soft palate increased by 7.5%, 15.8%, and 30.6%, respectively. Degree of palatal lengthening varied among surgeons and Veau cleft type but was not related to cleft width. Seven (4.0%) patients developed postoperative oronasal fistulas. Patients with a Veau IV cleft and larger cleft widths were at an increased risk for fistula formation. Conclusions: This study demonstrates that overall palatal lengthening occurs with the modified Furlow technique. Long-term follow-up studies are needed to determine the clinical relevance of these findings.

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.

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

A community-based long-term follow up of women undergoing obstetric fistula repair in rural Ethiopia

2009 ◽  
Vol 116 (9) ◽  
pp. 1258-1264 ◽  
Author(s):  
HS Nielsen ◽  
L Lindberg ◽  
U Nygaard ◽  
H Aytenfisu ◽  
OL Johnston ◽  
...  
Keyword(s):  
Obstetric Fistula ◽  
Fistula Repair ◽  
Community Based ◽  
Rural Ethiopia ◽  
Long Term Follow Up

Hydroxyapatite-Coated Femoral Stem Survivorship at 10 Years

2005 ◽  
Vol 284-286 ◽  
pp. 1069-0 ◽  
Author(s):  
Gregory Y. Lee ◽  
Ajay Srivastava ◽  
Darryl D. D'Lima ◽  
Pam Pulido ◽  
Clifford W. Colwell
Keyword(s):  
Polyethylene Wear ◽  
Femoral Stem ◽  
Senior Author ◽  
Independent Observer ◽  
Long Term Follow Up ◽  
The Mean ◽  
Lost To Follow Up ◽  
Hip Arthroplasties

The Omnifit-HA femoral stem component has shown excellent results in early clinical studies. This is an independent prospective study of the outcome of a ydroxyapatite-coated femoral component implanted by one surgeon with an intermediate-term follow up. The senior author performed 103 consecutive uncemented total hip arthroplasties in 96 patients from July 1991 to December 1996. The components implanted were the Omnifit-HA femoral stem and the Omnifit PSL porous-coated acetabular shell. The mean age at the time of the index procedure was 52 years old (range, 27–78) and male:female ratio was 54:42. Three patients were deceased and four patients were lost to follow-up. The mean follow up was 10.3 years (range, 7.3–12.7 years). Clinical and radiographic evaluations were performed by an independent observer. The average preoperative and postoperative Harris Hip Scores were 55 and 92, respectively. The overall survivorship of the Omnifit-HA stem was 100% with no femoral revisions. The survivorship of the Omnifit PSL cup was 89.7% with 4 acetabular revisions for aseptic loosening and 6 polyethelene liner exchanges for osteolysis or late instability. The mean polyethylene wear rate was 0.24 mm per year. This long-term follow up shows that the use of circumferentially coated hydroxyapatite stems can protect against the migration of wear debris along the femoral stem.

Induced Velopharyngeal Fatigue Effects in Speakers with Repaired Palatal Clefts

2007 ◽  
Vol 44 (3) ◽  
pp. 251-260 ◽  
Author(s):  
Jerald B. Moon ◽  
David P. Kuehn ◽  
Grace Chan ◽  
Lili Zhao
Keyword(s):  
Cleft Palate ◽  
Muscle Activity ◽  
Regression Line ◽  
Pressure Load ◽  
Nasal Side ◽  
Velopharyngeal Closure ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Nasal Pressure ◽  
Force Data

Objective: To address whether speakers with cleft palate exhibit velopharyngeal mechanism fatigue and are more susceptible to muscle fatigue than are speakers without cleft palate. Methods: Six adults with repaired palatal clefts and mild-moderate hypernasality served as subjects. Velopharyngeal closure force and levator veli palatini muscle activity were recorded. Subjects were asked to repeat /si/ 100 times while an external load consisting of air pressure (0, 5, 15, 25, 35 cm H2O) was applied via a mask to the nasal side of the velopharyngeal mechanism. Fatigue was defined as a reduction in velopharyngeal closure force across the series of /si/ productions, as evidenced by a negatively sloped regression line fit to the closure force data. Results: Absolute levels of velopharyngeal closure force were much lower than those observed previously in speakers without palatal clefts. All subjects showed evidence of fatigue. Furthermore, all subjects demonstrated exhaustion, where they were unable to close the velopharyngeal port against the nasal pressure load. This occurred at pressure load levels lower than those successfully completed by speakers without cleft palate. Conclusions: In speakers with a repaired palatal cleft, the velopharyngeal closure muscles may not possess the same strength and/or endurance as in normal speakers. Alternatively, muscles may possess adequate strength, but not be positioned optimally within the velopharynx following cleft palate repair or may be forced to move velopharyngeal structures that are stiffer as a result of surgical scarring.

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.

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