Management of palatal fistulas and a simple surgical algorithm proposal

Yıl 2020, Cilt: 33 Sayı: 1, 17 - 22, 31.01.2020

Fatma Nihal Durmus Kocaaslan Zuhra Memıc Dogus Yalcın Ozhan Celebıler

https://doi.org/10.5472/marumj.681988

Öz

Objectives: Despite improved techniques in repair of cleft palate, failure of healing of palatal structures resulting in a palatal fistula is one of the major challenges in the practice of reconstructive surgery. The aim of this study is to evaluate treatment success and failure in patients with palatal fistulas following cleft palate repair.
Patients and Methods: Totally 44 patients with a history of cleft palate who underwent surgery for palatal fistula were included in this study undertaken between January 1999 and August 2014. Fistulas were classified as anterior and posterior according to the repair technique and were repaired using one of the following techniques: buccal mucosal flap, tongue flap or mucoperiosteal flap.
Results: Success rate for anterior fistulas was 71.42% with tongue flap and 76.92% with mucoperiosteal flap. Success rate for posterior fistulas was 84.62% with mucoperiosteal flap and 75% with buccal mucosal flap. Difference in success rates between the anterior and posterior fistulas was not statistically significant. Conclusion: Our study results suggest the use of mucoperiosteal flaps for both anterior and posterior fistulas smaller than 5mm as the first choice, guided by the principle of replacing absent tissue with similar tissue.

Anahtar Kelimeler

Cleft palate, Palatal fistula, Post-palatoplasty fistula, Tongue flap, Two-flap palatoplasty

Kaynakça

• [1] Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft palate fistulas: A multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg 1991;87:1041–7.
• [2] Muzaffar AR, Byrd HS, Rohrich RJ, Johns DF, LeBlanc D, Beran SJ, et al. Incidence of cleft palate fistula: an institutional experience with two-stage palate repair. Plast Reconstr Surg 2001;108:1515–8.
• [3] Bykowski MR, Naran S, Winger DG, Losee JE. The rate of oronasal fistula following primary cleft palate surgery: A meta analysis. Cleft Palate Craniofac J 2015;52:81–7. doi: 10.1597/14-127.
• [4] Andersson E-M, Sandvik L, Semb G, et al. Palatal fistulas after primary repair of clefts of the secondary palate. Scand J Plast Reconstr Surg Hand Surg 2008;42:296-9. doi: 10.1080/028.443.10802299676.
• [5] Phua YS, de Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft plate repair: An audit of 211 children born between 1990 and 2004. Cleft Palate Craniofac J 2008;45:172–8. doi: 10.1597/06-205.1.
• [6] Farzaneh F1, Lindman R, Becker M, Hansen K, Svensson H. Von Langenbeck procedures at 14 months or Wardill at 18 months for primary repair of cleft palate in adult Swedish patients with bilateral complete cleft lip and palate: A study of facial growth. Scand J Plast Reconstr Surg Hand Surg 2009;43:214-24. doi: 10.1080/028.443.10903040789.
• [7] Lu Y, Shi B, Zheng Q, et al. Incidence of palatal fistula after palatoplasty with levator veli palatine retropositioning according to Sommerland. Br J Oral Maxillofac Surg 2010;48:637-40. doi: 10.1016/j.bjoms.2009.10.018.
• [8] Landheer JA, Breugmen CC, Mink van der Molen AB. Fistula incidence and predictors of fistula occurrence after cleft palate repair: two-stage closure versus one-stage closure. Cleft Palate Craniofac J 2010;47:623-30. doi: 10.1597/09-069.
• [9] Koudoumnakis E, Vlastos IM, Parpounas K, Houlakis M. Two-flap palatoplasty: description of the surgical technique and reporting of results at a single center. Ear Nose Throat J 2012; 91:E33-7.
• [10] Becker M, Hansson E. Low rate of fistula formation after Sommerlad palatoplasty with or without lateral incisions: an analysis of risk factors for formation of fistulas after palatoplasty. J Plast Reconstr Aesthet Surg 2013 ;66:697-703. doi: 10.1016/j.bjps.2013.01.031.
• [11] Murthy J. Descriptive study of management of palatal fistula in one hundred and ninety-four cleft individuals. Indian J Plast Surg 2011 ;44:41-6. doi: 10.4103/0970-0358.81447.
• [12] Smith DM, Vecchione L, Jang S, Ford M, Deleyiannis FW, Haralam MA, et al. The Pittsburgh fistula classification system: A standardized scheme for the e description of palatal fistulas. Cleft Palate Craniofac J 2007;44:590–4. doi: 10.1597/06-204.1.
• [13] Sunil Richardson, Nisheet A. Agni. Palatal Fistulae: A Comprehensive Classification and Difficulty Index. J Maxillofac Oral Surg 2014 ; 13: 305–309. doi: 10.1007/ s12663.013.0535-2.
• [14] Campbell DA. Fistulae in the hard palate following cleft palate surgery. Br J Plast Surg 1962;15:377–84.
• [15] Mukherji MM. Cheek flap for short palates.  Cleft Palate Craniofac J 1969;6:415–20.
• [16] Bianchi B, Ferri A, Ferri S, Copelli C, Sesenna E. Myomucosal cheek flaps: Aplication in intraoral reconstruction using three different techniques. Oral Surg Med Oral Pathoi Oral Radiol Endod 2009;108:353–9. doi: 10.1016/j.tripleo.2009.04.021.
• [17] Guerrero-Santos J, Altamirano JT. The use of lingual flaps in repair of fistulae of the hard palate. Plast Reconstr Surg 1966;38:123–4.
• [18] Rochrich RJ, Rowsell AR, Johns DF, et al. Timing of hard palatal closure: a critical long-term analysis. Plast Reconstr Surg 1996;98:236-46.
• [19] Emory RE, Clay RP, Bite U, et al. Fistula formation and repair after palatal closure: an institutional perspective. Plast Reconstr Surg 1997;99:1535-8.
• [20] Denny AD, Amm CA. Surgical technique for the correction of postpalatoplasty fistulae of the hard palate. Plast Reconstr Surg 2005;115:383–7.
• [21] Carsten MH. Sequential cleft management with the sliding sulcus technique and alveolar extension palatoplasty. J Craniofac Surg 1999;10:503–18.
• [22] Aldekhayel SA, Sinno H, Gilardino MS. Acellular dermal matrix in cleft palate repair: an evidence-based review. Plast Reconstr Surg 2012;130:177-82. doi: 10.1097/ PRS.0b013e318254b2dc.
• [23] Agir H1, Eren GG, Yasar EK. Acellular Dermal Matrix Use in Cleft Palate and Palatal Fistula Repair: A Potential Benefit? J Craniofac Surg 2015 Jul;26(5):1517-22. doi: 10.1097/ SCS.000.000.0000001814.
• [24] Diah E, Lo LJ, Yun C, Wang R, Wahyuni LK, Chen YR. Cleft oronasal fistula: A review of treatment results and a surgical management algorithm proposal. Chung Gang Med J 2007;30:529-37.