Palatal fistula rate after Huaxi Sommerlad-Furlow palatoplasty

doi:10.7518/hxkq.2020.02.010

Abstract

Abstract:

Objective This study aimed to determine the palatal fistula rate, explore the influencing factors of Huaxi Sommerlad-Furlow (SF) palatoplasty. Methods A retrospective review of 385 consecutive cleft-palate cases was performed to determine the incidence of postoperative fistula and assess the possible contributing factors, such as sex, weight, age, cleft type, operator skills, preoperative white blood cell, preventive antibiotic use, and postoperative temperature. Results Fistulas occurred in 15/385 patients (3.9%). Among them, 1 fistula was located at the junction of the hard and soft palates, 12 fistulas in hard palate, and 2 fistulas in alveolar near the hard palate. No evidence suggested that sex, weight, age, preoperative white blood cell, preventive antibiotic use, and postoperative temperature are associated with fistula formation. The incidences of cleft palate fistulas as encountered by senior professors (3.03%) and associate senior professors (2.23%) were significantly lower than those by attending doctors (14.29%, P<0.05). The incidences of cleft palate fistulas in bilateral completely cleft palate cases (20.6%) were significantly higher than those in hard and soft (3.6%) and unilateral cleft palate cases (2.6%, P<0.05). Conclusion Huaxi SF palatoplasty can avoid the inhibited maxillary growth without requiring lateral relaxing incision, which poses an acceptable risk of fistula formation. The palatal fistula rate is not related to the sex, weight, age of operation, prophylactic use of antibiotics before operation, infection before operation, temperature after operation and other factors. The occurrence of the fistula is related mainly to cleft type and experience level of the surgeon.

Key words: cleft palate, Huaxi Sommerlad-Furlow palatoplasty, palatal fistula

CLC Number:

R782.05

Wu Min, Zhu Zhibing, Shi Bing, Gong Caixia, Zhang Bihe, Li Yang. Palatal fistula rate after Huaxi Sommerlad-Furlow palatoplasty[J]. West China Journal of Stomatology, 2020, 38(2): 166-169.

Figures/Tables 1

References 26

[1]	Maeda K, Ojimi H, Utsugi R , et al. A T-shaped musculomucosal buccal flap method for cleft palate surgery[J]. Plast Reconstr Surg, 1987,79(6):888-896.
[2]	Senders CW, Sykes JM . Modifications of the Furlow palatoplasty (six- and seven-flap palatoplasties)[J]. Arch Otolaryngol Head Neck Surg, 1995,121(10):1101-1104.
[3]	Inman DS, Thomas P, Hodgkinson PD , et al. Oro-nasal fistula development and velopharyngeal insufficiency following primary cleft palate surgery: an audit of 148 children born between 1985 and 1997[J]. Br J Plast Surg, 2005,58(8):1051-1054.
[4]	Phua YS, de Chalain T . Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004[J]. Cleft Palate Craniofac J, 2008,45(2):172-178.
[5]	Lu Y, Shi B, Zheng Q , et al. Incidence of palatal fistula after palatoplasty with levator veli palatini retropositioning according to Sommerlad[J]. Br J Oral Maxillofac Surg, 2010,48(8):637-640.
[6]	Landheer JA, Breugem CC, van der Molen ABM . Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure[J]. Cleft Palate Craniofac J, 2010,47(6):623-630.
[7]	Muzaffar AR, Byrd HS, Rohrich RJ , et al. Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair[J]. Plast Reconstr Surg, 2001,108(6):1515-1518.
[8]	Schultz RC . Management and timing of cleft palate fistula repair[J]. Plast Reconstr Surg, 1986,78(6):739-747.
[9]	Amaratunga NA . Occurrence of oronasal fistulas in operated cleft palate patients[J]. J Oral Maxillofac Surg, 1988,46(10):834-837.
[10]	Andersson EM, Sandvik L, Semb G , et al. Palatal fistulas after primary repair of clefts of the secondary palate[J]. Scand J Plast Reconstr Surg Hand Surg, 2008,42(6):296-299.
[11]	MacKay D, Mazahari M, Graham WP , et al. Incidence of operative procedures on cleft lip and palate patients[J]. Ann Plast Surg, 1999,42(4):445-448.
[12]	Pulkkinen J, Haapanen ML, Paaso M , et al. Velopharyngeal function from the age of three to eight years in cleft palate patients[J]. Folia Phoniatr Logop, 2001,53(2):93-98.
[13]	Thaller SR . Staged repair of secondary cleft palate deformities[J]. J Craniofacial Surg, 1995,6(5):375-379.
[14]	Salimi N, Aleksejūnienė J, Yen EH , et al. Fistula in cleft lip and palate patients—a systematic scoping review[J]. Ann Plast Surg, 2017,78(1):91-102.
[15]	Ogata H, Sakamoto Y, Kishi K . Cleft palate repair without lateral relaxing incision[J]. Plast Reconstr Surg Glob Open, 2017,5(3):e1256.
[16]	Lithovius RH, Ylikontiola LP, Sándor GK . Incidence of palatal fistula formation after primary palatoplasty in northern Finland[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2014,118(6):632-636.
[17]	石冰 . 腭裂的个体化整复[J]. 国际口腔医学杂志, 2015,42(6):621-623.
	Shi B . Individualized surgical management of cleft palate[J]. J Int Stomatol, 2015,42(6):621-623.
[18]	王龑, 李承浩 . 唇腭裂手术治疗[M]. 北京: 人民军医出版社, 2015: 129-132.
	Wang Y, Li CH. Cleft lip and palate surgery[M]. Beijing：People’s Military Medical Press, 2015: 129-132.
[19]	Karsten A, Larson M, Larson O . Dental occlusion after Veau-Wardill-Kilner versus minimal incision technique repair of isolated clefts of the hard and soft palate[J]. Cleft Palate Craniofac J, 2003,40(5):504-510.
[20]	石冰, 邓典智, 王翰章 , 等. 腭裂及其修复术后上颌骨生长变化规律及机制的实验研究[J]. 华西口腔医学杂志, 1997,15(2):151-155.
	Shi B, Deng DZ, Wang HZ , et al. An experimental study of the growth pattern and mechanisms of surgically induced cleft palate and palatoplasty on maxillary growth in dogs[J]. West China J Stomatol, 1997,15(2):151-155.
[21]	王志勇, 石冰, 鲁大为 , 等. 颊、腭粘膜移植修复硬腭裸露骨面的组织学观察[J]. 华西口腔医学杂志, 2002,20(5):326-329.
	Wang ZY, Shi B, Lu DW , et al. A histological study on healing process of palatal wound with denuded bone restored with transplanted buccal or palatal mucosa[J]. West China J Stomatol, 2002,20(5):326-329.
[22]	Wilhelmi BJ, Appelt EA, Hill L , et al. Palatal fistulas: rare with the two-flap palatoplasty repair[J]. Plast Reconstr Surg, 2001,107(2):315-318.
[23]	Muzaffar AR, Byrd HS, Rohrich RJ , et al. Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair[J]. Plast Reconstr Surg, 2001,108(6):1515-1518.
[24]	Cohen SR, Kalinowski J, LaRossa D , et al. Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management[J]. Plast Reconstr Surg, 1991,87(6):1041-1047.
[25]	Emory RE Jr, Clay RP, Bite U , et al. Fistula formation and repair after palatal closure: an institutional perspective[J]. Plast Reconstr Surg, 1997,99(6):1535-1538.
[26]	Vityadewi N, Bangun K . Incidence of palatal fistula after one-stage palatoplasty and factors influencing the fistula occurrence[J]. J Plastik Rekonstruksi, 2013,2(4):120-125.