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. 2019 Jan;143(1):140e-151e.
doi: 10.1097/PRS.0000000000005169.

Pakistan Comprehensive Fistula Classification: A Novel Scheme and Algorithm for Management of Palatal Fistula/Dehiscence

Ghulam Qadir Fayyaz  1 , Nauman Ahmad Gill  1 , Irfan Ishaq  1 , Muhammad Aslam  1 , Ayesha Chaudry  1 , Muhammad Ashraf Ganatra  1 , Obaidullah Obaid  1 , Moazzam Nazeer Tarar  1 , Philip Kuo-Ting Chen  1 , Donald Rudolph Laub  1
Affiliations

Pakistan Comprehensive Fistula Classification: A Novel Scheme and Algorithm for Management of Palatal Fistula/Dehiscence

Ghulam Qadir Fayyaz et al. Plast Reconstr Surg. 2019 Jan.

Abstract

Background: It is not easy to find a management-based classification of palatal fistula in the literature. A few attempts have been made to classify the wide variety of fistulae that do not describe the fistula details comprehensively and guide toward its management. The authors have come across a wide variety of fistulae that could not be classified according to any of the prevailing classification systems. The presented classification gives a clear and exact understanding of location and size of fistula/dehiscence. Palatal function has been included as one of the important determinants for devising a management plan. Based on this classification, the authors have proposed an algorithm that encompasses clear guidelines for surgical treatment of these fistulae.

Methods: Over the past 15 years, the authors' team operated on 2537 palatal fistula patients. The medical records of these patients were reviewed to determine the location, size, and velopharyngeal competence. A new classification and algorithm were developed.

Results: Of 2537 patients, 2258 had midline fistulae, 208 had lateral fistulae, and 53 had subtotal fistulae. There were 18 patients with dehiscence. Recurrence developed in 181 patients.

Conclusion: The authors believe that this classification and algorithm can help follow a practical approach to manage palatal fistulae and dehiscence.

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