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Review
. 2023 Feb 1:23:e7.
eCollection 2023.

Cleft Palate Fistula: A Review

Mitchell Buller  1 , Diana Jodeh  1 , Fatima Qamar  1 , Joshua M Wright  1 , Jordan N Halsey  1 , S Alex Rottgers  1
Affiliations
Review

Cleft Palate Fistula: A Review

Mitchell Buller et al. Eplasty. .

Abstract

Background: The development of postoperative oronasal fistulae (ONF) is a complication that plagues all cleft surgeons to varying degrees. There is extensive literature discussing the incidence, functional impact, and treatment of ONF. The goal of this article is to provide an extensive review of the literature discussing the incidence, causative factors, functional impact, classification systems, and treatment of ONF.

Methods: A literature review was performed using PubMed using the Medical Subject Heading terms "cleft palate" AND "fistula" OR "palatal fistula" OR "oronasal fistula". After review, a total of 356 articles were deemed relevant for this study.

Results: Information regarding ONF care, prevention, and management in patients with cleft palate was collected from the articles included in this review. Treatment of ONF remains a challenging problem as there is not a consensus in the available literature on the best palatoplasty techniques for their prevention and treatment. A myriad of reconstructive options and adjunctive therapies exist, and their use is guided by the size and location of the fistula.

Conclusions: Fistula treatment should be tailored to the specific needs of the patient, and consideration must be given to not only the ONF itself but also the patient's stage of growth and development. Large-scale, multicenter studies are needed in which ONF are described using standardized nomenclature, and improved outcomes reporting is necessary to better define an algorithm for a truly holistic approach to palate surgery and reduce the incidence of palatal fistula.

Keywords: Classification; Cleft Palate Fistula; Oronasal Fistula; Palatal Fistula; Pittsburgh Fistula.

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Figures

Figure 1
Figure 1
Pittsburgh classification of palatal fistulas. This figure was reproduced with permission from Smith DM, Vecchione L, Jiang S, et al. The Pittsburgh fistula classification system: A standardized scheme for the description of palatal fistulas. Cleft Palate-Craniofac J. Nov 2007;44(6):590- 594. doi:10.1597/06-204.1. Copyright 2007 SAGE Publishing.
Figure 2
Figure 2
A) Preoperative markings for Furlow palatoplasty with bilateral relaxing incisions for Pittsburgh type IV fistula. B) Postoperative view of Pittsburgh type IV fistula reconstruction with Furlow palatoplasty and left buccal myomucosal flap.
Figure 2
Figure 2
A) Preoperative markings for Furlow palatoplasty with bilateral relaxing incisions for Pittsburgh type IV fistula. B) Postoperative view of Pittsburgh type IV fistula reconstruction with Furlow palatoplasty and left buccal myomucosal flap.
Figure 3
Figure 3
A) Preoperative view of Pittsburgh type V fistula. B) Postoperative view of Pittsburgh type V fistula reconstruction with facial artery musculomucosal flap.
Figure 3
Figure 3
A) Preoperative view of Pittsburgh type V fistula. B) Postoperative view of Pittsburgh type V fistula reconstruction with facial artery musculomucosal flap.
See this image and copyright information in PMC

References

    1. Dufresne C. Oronasal fistula and nasolabial fistulas. In: Bardach J, Morris HL. Multidisciplinary Management of Cleft Lip and Palate. 1st ed. W.B. Saunders; 1990:787-791.
    1. Cohen SR, Kalinowski J, Larossa D, et al. Cleft-palate fistulas—a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg. Jun 1991;87(6):1041-1047. doi:10.1097/00006534-199106000-00005 - DOI - PubMed
    1. Muzaffar AR, Byrd HS, Rohrich RJ, et al. Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair. Plast Reconstr Surg. Nov 2001;108(6):1515-1518. doi:10.1097/00006534-200111000-00011 - DOI - PubMed
    1. Jackson IT, Moreira-Gonzalez AA, Rogers A, Beal BJ. The buccal flap - A useful technique in cleft palate repair? Cleft Palate Craniofac J. Mar 2004;41(2):144-151. doi:10.1597/02-124 - DOI - PubMed
    1. Bindingnavele VK, Bresnick SD, Urata MM, et al. Superior results using the islandized hemipalatal flap in palatoplasty: experience with 500 cases. Plast Reconstr Surg. Jul 2008;122(1):232-239. doi:10.1097/PRS.0b013e31817741e8 - DOI - PubMed

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