Can Same Local Mucosal Tissue be Used for Recurrent Palatal Fistulas?

Purpose

 The purpose of this study is to obtain clues about the quality and usability of peri-fistular local tissue in recurrent fistulas operations from the results of patients who have undergone fistula surgery.

Materials and Methods

In this retrospective study, 53 fistula repair operations performed between 2009 and 2016 were classified as group 1 (successful results, n:33) and group 2 (unsuccessful results, n:20). These groups were subgrouped as operated by using local tissues (local tissue group, LTG), and using regional tissues (regional tissue group, RTG). Regional tissue group has been excluded from the study. Peri-fistular local tissue was investigated from intraoperative photos for all patients. Perifistular tissues scored according to, presence of a whiter tissue different from the normal palatal mucosa like scar tissue (there is:1 point, there isn’t :0 point) , clearing of the palatal rugas (there is:1 point, there isn’t :0 point), the presence of a flatter and thin palatal tissue around the fistula  (there is:1 point, there isn’t :0 point). 26 of group 1 were treated using local tissues. It was seen that the 22 of  patients had up to 1 point mentioned above. 17 of the group 2 were treated using local tissues. It was seen that the 9 of patients had up to 1 point mentioned above .

 Results

53 fistula operations performed in 43 patients were evaluated. Patient’s ages ranged from 2 to 45 years with a mean age of 20.4 years. Twenty of these patients were male and 23 were female. After the groups were designed as mentioned above, Chi-Square test analysis results were obtained with the Spss15.0 program. According to this; the success rate is 7.7% in patients had 2 or more points. This rate was 72.7% when the patients had 1 or less points.

Discussion

The incidence of fistula after primer palatoplasty ranges between 15-65%.  (1)  Any unsuccessful surgery applied to the fistulas not only may result in formation of larger fistulas, but also may not provide adequate occlusion due to the contraction phase of wound healing . When choosing the fistula repair method, it will be helpful for us to examine the local tissue condition in addition to the factors such as the type of fistula, localization, age of the patient, and patient's compliance. According to factors that mentioned above , it can be say , 2 or more point means that using of the local tissues to cover a fistula will most likely to fail. It is more rational to use regional or distant tissue in such situations.

References

1. Sunil Richardson,James S. Hoyt, Rohit K. Khosla, Rakshit Vijay Sinai Khandeparker, Vihang Y. Sukhadia, and Nisheet Agni, Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study, J Korean Assoc Oral Maxillofac Surg. 2016 Apr;42(2):77-83