Treatment Outcomes in Four- to Seven-Year-Old Patients with Cleft Lip and Cleft Palate in Tawanchai Center, Srinagarind Hospital: Fistula Incidence after Cleft Palate Repair
Punyavong P, MD1, Pradubwong S, MSN2, Winaikosol K, MD1, Jenwitheesuk K, MD1, Surakunprapha P, MD1, Chowchuen B, MD, MBA1
Affiliation : 1 Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 Division of Nursing, Srinagarind Hospital of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Oronasal fistulae is an undesirable complication of cleft palate repair. A fistula may affect speech, eating, and socialization.
Objective : The purpose of the present study was to determine the prevalence of fistulae in patients who underwent primary cleft
palate repair in Tawanchai Center, as well as to determine the factors that influence to fistulae.
Materials and Methods : A retrospective review was conducted of 96 consecutive patients between the ages of four and seven years
who underwent primary cleft palate repair in Tawanchai Center at Khon Kaen University’s Srinagarind Hospital. Data regarding
patient demographics, age at the time of primary repair, cleft type by Veau classification, cleft width, operative technique, and
surgeon’s year-experiences were recorded. The incidence rates of fistulae was the primary outcomes. The associations of gender,
age at the time of repair, cleft type, cleft width, and surgeon’s year-experiences with the incidence of fistulae were secondary outcomes.
Results : There were a total of 96 consecutive patients (57 boys [59.4%] and 39 girls [40.6%]). The Mean age at primary palatoplasty
was 12.9 months. The mean follow-up time after repair was 76.4 months. All patients underwent primary two-flap palatoplasty.
Post-surgical fistulae were 26 (27.08%). There were 20 (20.8%) patients with symptomatic fistulae that required surgical closure.
Fistulae mostly occurred at the incisive foramen (13 cases). Patients with clefts more than 1.0 cm wide and Veau cleft type IV were
more likely to develop post-operative oronasal fistulae (Adjusted Odds Ratio 10.29; 95% CI = 2.10 to 50.41, p = 0.004, Adjusted odds
ratio 0.10; 95% CI = 0.01 to 0.97, p = 0.04 respectively).
Conclusion : The overall number of post-surgical fistulae were moderate rate in patients who had undergone primary cleft palate
repair in Tawanchai Center. Cleft width at the time of cleft palate repair and Veau cleft type were a predictive factor for the development
of post-operative fistulae.
Keywords : Cleft palate, Cleft palate repair, Oronasal fistula
