Abstract
Introduction
Palatal fistula formation is a known complication of palatoplasty. Numerous classifications have been proposed that help in identifying the location of fistula and systematically arrange data for record keeping. They do not assess the difficulty level of the fistula. Management of fistulae can be very tricky and a definitive success cannot be guaranteed even in the best of hands. Hence we devised a classification system and a difficulty index to help evaluate the difficulty level and plan the treatment accordingly to predict the prognosis prior to surgery.
Materials and Methods
We reviewed 610 cases of palatal fistula operated at our center with a minimum follow-up of 6 months from May 2003 to May 2010. They were classified according to our classification. Difficulty index was also assessed. The data was tabulated and analysed.
Results
Longitudinal fistulae showed a recurrence rate of 7.87 % whereas transverse fistulae showed a recurrence rate of 19.66 %. Total recurrence rate was 11.31 %. Unilateral clefts with fistulae showed a recurrence of 6.55 % whereas bilateral clefts with fistulae showed a recurrence of 14.17 %. A total of 220 Grade 1 and 390 Grade 2 fistulae were managed. Out of these, 7 (3.18 %) Grade 1 and 62 (15.90 %) Grade 2 fistulae recurred. 90 % of failed fistulae showed decrease in the size of the fistula.
Conclusion
Classification and evaluation of difficulty of palatal fistula is essential to plan the surgical treatment so as to give better results. Bidimensional fistulae in the anterior hard palate are associated with higher recurrence rate. Also, fistulae in bilateral clefts are more difficult to close than those in unilateral clefts. Classification of fistulae according to the difficulty index helps in pre-operative judgment of the outcome.
Similar content being viewed by others
References
Smith DM, Vecchione L, Jiang S et al (2007) The Pittsburgh fistula classification system: a standardized scheme for the description of Palatal fistulas. Cleft Palate Craniofac J 44(6):590–594
Schultz RC (1986) Management and timing of cleft palate fistula repair. Plast Reconstr Surg 78:739–747
Wilhelmi BJ, Appelt EA, Hill L et al (2001) Palatal fistulas: rare with the two-flap palatoplasty repair. Plast Reconstr Surg 107:315–318
Padwa BL, Mulliken JB (2003) Complications associated with cleft lip and palate repair. Oral Maxillofac Surg Clin N Am 15:285–296
Cohen SR, Kalinowski J, LaRossa D et al (1991) Cleft palate fistulas: a multivariate, statistical analysis of prevalence, etiology and surgical management. Plast Reconstr Surg 87:1041–1047
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Richardson, S., Agni, N.A. Palatal Fistulae: A Comprehensive Classification and Difficulty Index. J. Maxillofac. Oral Surg. 13, 305–309 (2014). https://doi.org/10.1007/s12663-013-0535-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12663-013-0535-2