Difficulty Index Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience

Publication date: Available online 18 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Shruthi Saralaya, Anil Kumar Desai, Niranjan Kumar

Abstract

Purpose

This study highlight's the occurrence of different palatal fistula and evaluates the difficulty level in planning the treatment thereby predicting the prognosis pre-operatively.

Methods

This retrospective study included 62 non-syndromic cases with primary surgery and palatal fistula repair done in our unit. Data collected on the incidence, site & size of fistula, type of cleft, the method of fistula closure and all these categorized, analyzed and scored according to difficulty index put forward by Richardson et al. Data were statistically analyzed using Chi-square analysis and Fisher exact test.

Results

Incidence of palatal fistula was 4.58% with the transverse type (74%) as the predominant type. The Grade I and Grade II index comprised 33 (53.2%) and 29 (46.8%) patients, respectively. The recurrence rate was 35.4%, of which 6.4 and 28.9% observed in Grade I and Grade II difficulty index, respectively; hence, where related to the difficulty index (p=0.019). Surgical techniques included tongue flap, redopalatoplasty, rotation flap and a combination of a rotation with the buccal pad of fat. With p=0.047, the recurrence depended on the type of surgical management and the difficulty index.

Conclusion

Palatal fistula closure is a technically difficult procedure with a high recurrence rate. Hence, the difficulty level for closure must be evaluated to predict the outcome of the procedure before surgery. Also, further studies are required to introduce a standardized classification system showing the complexity of fistula to address the difficulty in their management.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2S7lL0F