Islanded Greater Palatine Artery Flap for Anterior Oronasal Fistula Repair

Introduction: Oronasal fistulae following palatoplasty may affect patients’ quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients’ quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health ( P = .05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction.

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

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620959528 ◽

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.

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Oronasal Fistula Repair with Three Layers

Plastic & Reconstructive Surgery ◽

10.1097/00006534-200101000-00021 ◽

2001 ◽

Vol 107 (1) ◽

pp. 143-147 ◽

Cited By ~ 15

Author(s):

George L. Murrell ◽

Ricardo Requena ◽

Daniel W. Karakla

Keyword(s):

Fistula Repair ◽

Oronasal Fistula

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Oronasal Fistula Repair Utilizing a Temporalis Muscle Flap in a Dog with Severe Trismus

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5699 ◽

2011 ◽

Vol 47 (6) ◽

pp. 447-454 ◽

Cited By ~ 3

Author(s):

Ryan P. Cavanaugh ◽

James P. Farese ◽

Nicholas J. Bacon ◽

David M. Lurie ◽

Rowan J. Milner

Keyword(s):

Squamous Cell Carcinoma ◽

Muscle Flap ◽

Complete Recovery ◽

Temporalis Muscle ◽

Fistula Repair ◽

Curative Intent ◽

Oronasal Fistula ◽

Maxillary Defect ◽

Successful Resolution ◽

Temporalis Muscle Flap

A 9 yr old spayed female cocker spaniel presented for evaluation of an invasive maxillary squamous cell carcinoma. Curative intent surgery and radiation therapy allowed for local control of the neoplasm; however, the development of a persistent oronasal fistula prevented a complete recovery. A temporalis myofascial rotation flap allowed for successful resolution of the maxillary defect. Implementation of the flap was relatively simple and was associated with few complications.

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