Background: Palatal fistula rates after primary repair are reported to range between three and twenty-nine percent. Protocols differ among surgeons in regard to a postoperative feeding regimen because many surgeons believe this affects the long term outcome after repair. This review was performed in order to compare the palatal fistula rate of patients in our institution, who were allowed to feed with a bottle immediately postoperatively, to the reported rate of postoperative palatal fistula.

Methods: A retrospective chart review of Veau Class II, III, and IV primary palatal repairs was undertaken. All repairs were performed by the same surgeon between 1993 and 2005 using a one stage palatal repair. Pre and postoperative records along with operative reports were reviewed for 48 Class II, 35 Class III, and 15 Class IV palates. The presence of fistulae seen postoperatively were recorded from the first year of postoperative visits. Alveolar fistulae intentionally left unrepaired were not recorded for the purposes of this study.

Results: All children were allowed unrestricted feeding with a bottle and cross-cut premie nipple. Pacifiers were not allowed. The overall fistula rate for palatal repairs allowed to bottle-feed immediately postoperatively was 13.2%. The fistula rates for each Veau Class were: Class II 14.5% (N=7/48), Class III 8.6% (N=3/35), and Class IV 20%(N=3/15). Factors that appeared to be more influential on fistula formation than feeding protocol were noted to be postoperative fever, otitis, need for reintubation, and parental care postoperatively.

Conclusion: Immediate postoperative feeding with a cross-cut premie nipple and bottle do not appear to adversely affect fistula rates after cleft palate repair.

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