16.0: Thursday, March 17, 2005

The Challenge to Avoid Fistulas in Primary Cleft Palate Repair

Sumeet S. Teotia, MD, John A. Van Aalst, MD, and H. Wolfgang Losken, MBChB, FCS, FRCS.

Purpose: To prospectively evaluate and significantly reduce fistula rate after primary cleft palate repair in an academic setting. Fistula rates as high as 45% have been reported.

Methods: 97 consecutive primary cleft palate repairs were performed with a single craniofacial surgeon at an accredited plastic surgery residency during a three year period. Closure of cleft palates was surgically achieved using accepted techniques: Furlow double opposing Z-plasty (cleft width 1-4 mm), Furlow or Von Langenback repair (5-7 mm), and Bardach variation of the Veau-Wardill-Kilner (8-15 mm). Alveolar clefts were not repaired. One-half of each surgical procedure was performed by plastic surgery residents under supervision. A fistula was defined as any opening in the secondary palate after repair. Multi-disciplinary follow-up was obtained.

Results: Ten plastic surgery residents operating on one-half of each cleft palate yielded a fistula rate of 3.1% (3 out of 97). Split uvula occurred in 3 out of 97 patients (3.1%). Median number of operations per resident was 11 (range 3-19).

Conclusion: Our experience summarizes the lowest reported fistula rate overall. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a low fistula rate. Technical details necessary to avoid a palatal fistula are discussed.