Achieving low cleft palate fistula rates: Surgical results and techniques

H. Wolfgang Losken, John A. Van Aalst, Sumeet S. Teotia, Shay B. Dean, Scott Hultman, Kim S. Uhrich

Research output: Contribution to journalArticle

Abstract

Objectives: To prospectively evaluate and reduce fistula rate after primary cleft palate repair in an academic setting. Methods: After noting an institutional palate fistula rate of 35.8%, when a majority of palatoplasties were performed using the Furlow double-opposing Z-plasty, the decision was made to re-evaluate the surgical techniques used for palate repair. As part of our re-evaluation, Furlow and von Langenbeck repairs were limited to clefts less than 8 mm in width. Wider clefts were repaired early in the series with Veau-Wardill-Kilner and later with Bardach two-flap palatoplasties. Half of each palate repair was performed by the residents. Setting: Multidisciplinary follow-up was obtained at the University of North Carolina Craniofacial Center. Results: A palate fistula was noted in 2 (1.6%) out of 126 cleft palate repairs (both fistulas were located at the anterior hard palate). A split uvula was identified in 2 of 59 patients where the status of the uvula was reported (3.4%). Conclusion: This study summarizes one of the lowest overall fistula rates reported in the literature. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a very low fistula rate. Technical keys to achieving low fistula rate include skeletonization of the vascular pedicle for medialization of the mucoperiosteal flaps, aggressive posterior repositioning of the levator muscle, and meticulous two-layer mattress-suture closure. We recommend Furlow repair for narrower clefts (less than 8 mm wide at the posterior border of the hard palate) and the Bardach two-flap palatoplasty for wider clefts.

Original languageEnglish (US)
Pages (from-to)312-320
Number of pages9
JournalCleft Palate-Craniofacial Journal
Volume48
Issue number3
DOIs
StatePublished - May 1 2011
Externally publishedYes

Fingerprint

Cleft Palate
Fistula
Palate
Uvula
Hard Palate
Tertiary Healthcare
Plastic Surgery
Sutures
Blood Vessels
Muscles

Keywords

  • Cleft outcomes
  • Cleft palate
  • Palate
  • Palate fistula
  • Palatoplasty

ASJC Scopus subject areas

  • Oral Surgery
  • Otorhinolaryngology

Cite this

Losken, H. W., Van Aalst, J. A., Teotia, S. S., Dean, S. B., Hultman, S., & Uhrich, K. S. (2011). Achieving low cleft palate fistula rates: Surgical results and techniques. Cleft Palate-Craniofacial Journal, 48(3), 312-320. https://doi.org/10.1597/08-288

Achieving low cleft palate fistula rates : Surgical results and techniques. / Losken, H. Wolfgang; Van Aalst, John A.; Teotia, Sumeet S.; Dean, Shay B.; Hultman, Scott; Uhrich, Kim S.

In: Cleft Palate-Craniofacial Journal, Vol. 48, No. 3, 01.05.2011, p. 312-320.

Research output: Contribution to journalArticle

Losken, HW, Van Aalst, JA, Teotia, SS, Dean, SB, Hultman, S & Uhrich, KS 2011, 'Achieving low cleft palate fistula rates: Surgical results and techniques', Cleft Palate-Craniofacial Journal, vol. 48, no. 3, pp. 312-320. https://doi.org/10.1597/08-288
Losken, H. Wolfgang ; Van Aalst, John A. ; Teotia, Sumeet S. ; Dean, Shay B. ; Hultman, Scott ; Uhrich, Kim S. / Achieving low cleft palate fistula rates : Surgical results and techniques. In: Cleft Palate-Craniofacial Journal. 2011 ; Vol. 48, No. 3. pp. 312-320.
@article{17c7680e246a4a778d58c5025695df87,
title = "Achieving low cleft palate fistula rates: Surgical results and techniques",
abstract = "Objectives: To prospectively evaluate and reduce fistula rate after primary cleft palate repair in an academic setting. Methods: After noting an institutional palate fistula rate of 35.8{\%}, when a majority of palatoplasties were performed using the Furlow double-opposing Z-plasty, the decision was made to re-evaluate the surgical techniques used for palate repair. As part of our re-evaluation, Furlow and von Langenbeck repairs were limited to clefts less than 8 mm in width. Wider clefts were repaired early in the series with Veau-Wardill-Kilner and later with Bardach two-flap palatoplasties. Half of each palate repair was performed by the residents. Setting: Multidisciplinary follow-up was obtained at the University of North Carolina Craniofacial Center. Results: A palate fistula was noted in 2 (1.6{\%}) out of 126 cleft palate repairs (both fistulas were located at the anterior hard palate). A split uvula was identified in 2 of 59 patients where the status of the uvula was reported (3.4{\%}). Conclusion: This study summarizes one of the lowest overall fistula rates reported in the literature. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a very low fistula rate. Technical keys to achieving low fistula rate include skeletonization of the vascular pedicle for medialization of the mucoperiosteal flaps, aggressive posterior repositioning of the levator muscle, and meticulous two-layer mattress-suture closure. We recommend Furlow repair for narrower clefts (less than 8 mm wide at the posterior border of the hard palate) and the Bardach two-flap palatoplasty for wider clefts.",
keywords = "Cleft outcomes, Cleft palate, Palate, Palate fistula, Palatoplasty",
author = "Losken, {H. Wolfgang} and {Van Aalst}, {John A.} and Teotia, {Sumeet S.} and Dean, {Shay B.} and Scott Hultman and Uhrich, {Kim S.}",
year = "2011",
month = "5",
day = "1",
doi = "10.1597/08-288",
language = "English (US)",
volume = "48",
pages = "312--320",
journal = "Cleft Palate-Craniofacial Journal",
issn = "1055-6656",
publisher = "American Cleft Palate Craniofacial Association",
number = "3",

}

TY - JOUR

T1 - Achieving low cleft palate fistula rates

T2 - Surgical results and techniques

AU - Losken, H. Wolfgang

AU - Van Aalst, John A.

AU - Teotia, Sumeet S.

AU - Dean, Shay B.

AU - Hultman, Scott

AU - Uhrich, Kim S.

PY - 2011/5/1

Y1 - 2011/5/1

N2 - Objectives: To prospectively evaluate and reduce fistula rate after primary cleft palate repair in an academic setting. Methods: After noting an institutional palate fistula rate of 35.8%, when a majority of palatoplasties were performed using the Furlow double-opposing Z-plasty, the decision was made to re-evaluate the surgical techniques used for palate repair. As part of our re-evaluation, Furlow and von Langenbeck repairs were limited to clefts less than 8 mm in width. Wider clefts were repaired early in the series with Veau-Wardill-Kilner and later with Bardach two-flap palatoplasties. Half of each palate repair was performed by the residents. Setting: Multidisciplinary follow-up was obtained at the University of North Carolina Craniofacial Center. Results: A palate fistula was noted in 2 (1.6%) out of 126 cleft palate repairs (both fistulas were located at the anterior hard palate). A split uvula was identified in 2 of 59 patients where the status of the uvula was reported (3.4%). Conclusion: This study summarizes one of the lowest overall fistula rates reported in the literature. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a very low fistula rate. Technical keys to achieving low fistula rate include skeletonization of the vascular pedicle for medialization of the mucoperiosteal flaps, aggressive posterior repositioning of the levator muscle, and meticulous two-layer mattress-suture closure. We recommend Furlow repair for narrower clefts (less than 8 mm wide at the posterior border of the hard palate) and the Bardach two-flap palatoplasty for wider clefts.

AB - Objectives: To prospectively evaluate and reduce fistula rate after primary cleft palate repair in an academic setting. Methods: After noting an institutional palate fistula rate of 35.8%, when a majority of palatoplasties were performed using the Furlow double-opposing Z-plasty, the decision was made to re-evaluate the surgical techniques used for palate repair. As part of our re-evaluation, Furlow and von Langenbeck repairs were limited to clefts less than 8 mm in width. Wider clefts were repaired early in the series with Veau-Wardill-Kilner and later with Bardach two-flap palatoplasties. Half of each palate repair was performed by the residents. Setting: Multidisciplinary follow-up was obtained at the University of North Carolina Craniofacial Center. Results: A palate fistula was noted in 2 (1.6%) out of 126 cleft palate repairs (both fistulas were located at the anterior hard palate). A split uvula was identified in 2 of 59 patients where the status of the uvula was reported (3.4%). Conclusion: This study summarizes one of the lowest overall fistula rates reported in the literature. In a tertiary-care academic setting, plastic surgery residents can actively contribute to palatoplasty with a very low fistula rate. Technical keys to achieving low fistula rate include skeletonization of the vascular pedicle for medialization of the mucoperiosteal flaps, aggressive posterior repositioning of the levator muscle, and meticulous two-layer mattress-suture closure. We recommend Furlow repair for narrower clefts (less than 8 mm wide at the posterior border of the hard palate) and the Bardach two-flap palatoplasty for wider clefts.

KW - Cleft outcomes

KW - Cleft palate

KW - Palate

KW - Palate fistula

KW - Palatoplasty

UR - http://www.scopus.com/inward/record.url?scp=79955929892&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955929892&partnerID=8YFLogxK

U2 - 10.1597/08-288

DO - 10.1597/08-288

M3 - Article

C2 - 20815713

AN - SCOPUS:79955929892

VL - 48

SP - 312

EP - 320

JO - Cleft Palate-Craniofacial Journal

JF - Cleft Palate-Craniofacial Journal

SN - 1055-6656

IS - 3

ER -