Frequency of Fistula Formation in Primary Cleft Palate Repair in a Tertiary Care Hospital

Maimoona Goher; Saad ur Rehman Sarwar; M Ibrahim Khan; Mamoon Rashid; Sakina Malik; Farwa Shabbir

doi:10.51253/pafmj.v76i3.9814

Authors

Maimoona Goher Department of Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, Pakistan
Saad ur Rehman Sarwar Department of Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, Pakistan
M Ibrahim Khan Department of Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, Pakistan
Mamoon Rashid Department of Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, Pakistan
Sakina Malik Department of Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, Pakistan
Farwa Shabbir Department of Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i3.9814

Keywords:

Cleft Palate, Fistula, Frequency, Oronasal, Palate Repair

Abstract

Objective: To determine the frequency of fistula formation after primary cleft palate repair in a tertiary care facility.

Study Design: Retrospective Longitudinal Study.

Place and Duration of Study: Plastic and Reconstructive Surgery Department, Shifa International Hospital, Islamabad, Pakistan, from Jan 2017 to Dec 2021.

Methodology: A total of 176 patients were included. Data was extracted from the electronic medical record. Veau classification was used for identifying the severity of the cleft. The mean age of these children at the repair was 11 months. Techniques used for repair included Von Langenbeck, Bardach’s, one-sided Von Langenbeck and one-sided Bardach (Hybrid) and Furlow’s palatoplasty.

Results: The outcomes were assessed using Pittsburgh classification of fistula. Mean follow-up was 12 months. Eight out of 176 patients developed oronasal fistula, making the frequency of fistula to be 4.5%. The most common location for fistula formation was the hard palate 5(2.84%), followed by the split uvula 2(1.14%), and junction of the hard and soft palate 1(0.57%). Fistula occurrence was higher in Veau III and IV clefts (p=0.013). However, the frequency of fistula correlates significantly among various surgical techniques.

Conclusion: The overall frequency of fistula formation was 4.5% in our study, with frequency increasing with the severity of the cleft. Key to decreasing the frequency of fistula in cleft palate patients is to observe good surgical practice by improved mobilization of flaps, dissection around the pedicle, tension-free layered closure, and post-operative care.

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