Incidence of cleft palate fistula: An institutional experience with two-stage palatal repair

The purpose of this study was to determine the incidence of cleft palatal f istula in a series of nonsyndromic children treated at the authors' institu tion. This retrospective analysis of 103 patients with cleft palate treated by five surgeons between 1982 and 1995 includes 60 boys and 33 girls, whos e median age was 18.4 months at the Lime of surgery. The median length of f ollow-up was 4.9 years after primary palatoplasty. Cleft palatal fistula wa s defined as a failure of healing or a breakdown in the primary surgical re pair of the palate, Intentionally unrepaired fistulas of the primary and se condary palate were excluded. Extent of clefting was described according to the Veau classification. Statistical examination of multiple variables was performed using contingency table analysis, multivariate logistic regressi on, and the Wilcoxon rank sum test. The incidence of cleft palatal fistula in this series was 8.7 percent. All of these fistulas were clinically signi ficant. The rate of fistula recurrence was 33 percent. The incidence of cle ft palatal fistula when compared by Veau classification was statistically s ignificant, with nine fistulas occurring in patients wish Wan 3 and 4 cleft s and no fistulas occurring in patients with Veau 1 and 2 clefts (p = 0.044 1). No significant differences between patients with and without fistulas w ere identified with respect to operating surgeon, patient sex, patient age at palatoplasty, type of palatoplasty, and use of presurgical orthopedics o r palatal expansion. All three recurrent fistulas occurred in the anterior palate, two in patients with Veau class 3 clefts and one in a patient with a Wan class 4 cleft. The low rate of clinically significant fistula was att ributed to early delayed primary closure, with smaller secondary clefts all owing repair with a minimum of dissection and disruption of vascularity.