Difficulty Index-Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience
| Autor: | Anil Kumar Desai, Shruthi Saralaya, Niranjan Kumar |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Rotation flap medicine.medical_specialty Adolescent Fistula medicine.medical_treatment Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine medicine Humans Child Retrospective Studies Buccal fat pad business.industry Incidence (epidemiology) Infant Retrospective cohort study 030206 dentistry Plastic Surgery Procedures medicine.disease Surgery Cleft Palate Exact test Palatoplasty Otorhinolaryngology Oral Fistula Child Preschool 030220 oncology & carcinogenesis Female Oral Surgery business |
| Zdroj: | Journal of Oral and Maxillofacial Surgery. 77:851.e1-851.e7 |
| ISSN: | 0278-2391 |
| DOI: | 10.1016/j.joms.2018.12.005 |
| Popis: | Purpose In the present study, we have highlighted the occurrence of different palatal fistulas and evaluated the difficulty level in planning the treatment, thereby enabling the prediction of the prognosis preoperatively. Materials and Methods The present retrospective study included 62 nonsyndromic cases with primary surgery and palatal fistula repair performed in our unit. Data were collected on the fistula incidence, site, and size, cleft type, fistula closure method. All these were categorized, analyzed, and scored according to the difficulty index reported by Richardson et al. The data were statistically analyzed using χ2 analysis and Fisher's exact test. Results The incidence of palatal fistula was 4.58%, with the transverse type (74%) the predominant type. The difficulty index was grade 1 and 2 for 33 (53.2%) and 29 (46.8%) patients, respectively. The recurrence rate was 35.4%, with 6.4 and 28.9% observed in the grade 1 and grade 2 groups, respectively (P = .019). The surgical techniques included tongue flap, redo palatoplasty, rotation flap, and a combination of rotation with a buccal fat pad. The incidence of recurrence was dependent on the type of surgical management and the difficulty index score (P = .047). Conclusions Palatal fistula closure is a technically difficult procedure with a high recurrence rate. Thus, the difficulty level index for closure must be evaluated to predict the outcomes of the procedure before surgery. Also, further studies are required to introduce a standardized classification system of fistula complexity to address the difficulty in their management. |
| Databáze: | OpenAIRE |
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