FISTULA FORMATION AND REPAIR AFTER PALATAL CLOSURE - AN INSTITUTIONALPERSPECTIVE

We retrospectively reviewed 119 consecutive patients who underwent cle ft palate repair at the Mayo Clinic to determine the incidence of post operative fistula formation, to assess possible contributing factors, and to review the methods of surgical management. Fistulas of the seco ndary palate were included, but nasal-alveolar fistulas and intentiona lly unrepaired anterior palatal fistulas were excluded. Six patients w hose repairs were performed after 2.5 years of age were excluded to en sure a more uniform patient population. Cleft palate fistulas occurred in 13 of the 113 patients (11.5 percent). The median age at repair wa s 8.2 months. and the median follow-up period was 5.2 years. Several v ariables were analyzed by means of the log-rank test to determine thei r significance in postoperative fistula formation. Sex, extent of clef ting (as estimated by the Veau classification), and type of palatal cl osure did not significantly affect the rate of fistula formation. Howe ver, patients; who had palatal closure at an age younger than 12 month s had a lower incidence of fistula formation (7.8 percent) than childr en whose closures were performed between the ages of 12 and 25 months (19.4 percent) (p = 0.058). The strongest predictor of the occurrence of a cleft palate fistula was the surgeon performing the procedure (p = 0.008). Fistula repair was deemed necessary in 11 of 13 patients, an d 91 percent of these fistulas were healed with a single operation. Mo st of these fistulas were closed by using local flaps and two-layered closures. Cleft palate repair carries a significant but acceptable ris k of fistula formation, which can be managed with local flaps. Fistula occurrence is related most to the experience level of the operating s urgeon.