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Law MYT, Chung RWC, Lam OLT. Prosthetic rehabilitation of an edentulous patient with an oronasal fistula. J Prosthet Dent 2015; 113:347-9. [PMID: 25681354 DOI: 10.1016/j.prosdent.2014.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022]
Abstract
The presence of an oronasal fistula presents a challenge to maxillary complete denture fabrication because leakage of air from the nasal cavity through the fistula prevents the formation of an adequate border seal. Although surgical repair or dental implants are possible solutions, these options are invasive and sometimes not feasible. This clinical report illustrates an alternative prosthetic solution by integrating a small retentive component into a maxillary complete denture.
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Affiliation(s)
- Mike Y T Law
- Postgraduate student, Department of Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Robin W C Chung
- Clinical Lecturer and Fellow, Department of Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Otto L T Lam
- Assistant Professor, Department of Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
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102
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Li H, Yin N, Song T. Oronasal fistula repair using the alveolar ridge approach. Int J Pediatr Otorhinolaryngol 2015; 79:161-4. [PMID: 25542863 DOI: 10.1016/j.ijporl.2014.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/20/2014] [Accepted: 11/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Use the alveolar ridge approach operation to repair anterior palate oronasal fistulae. METHODS In this study, oronasal communication defects were covered with in situ mucosal flaps, resulting in reduced palatal leakage bilaterally. This treatment approach not only provides good esthetic appearance results, but also prevents food and liquid leakage into nose. RESULTS 25 patients were considered in this study. The alveolar ridge approach for the complication of anterior palate oronasal fistula was a good alternative for these patients; no incision scars were created, and the physiological state after surgery is optimized, with the resulting outcome most closely approximating true anatomic repair. Mucosal and gingival lateral palatal mucosa post-surgical healing results also were good, with return to a natural position. CONCLUSION Oronasal fistula repair with the alveolar ridge approach is an easy and perhaps ideal method, with a high success rate.
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Affiliation(s)
- Haidong Li
- Plastic Surgery Hospital of the Chinese Academy of Medical Science and Peking Union Medical College, Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144, People's Republic of China.
| | - Ningbei Yin
- Plastic Surgery Hospital of the Chinese Academy of Medical Science and Peking Union Medical College, Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144, People's Republic of China.
| | - Tao Song
- Plastic Surgery Hospital of the Chinese Academy of Medical Science and Peking Union Medical College, Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100144, People's Republic of China
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El-Kassaby MA, Khalifah MAAJ, Metwally SA, Abd ElKader KAE. Acellular dermal matrix allograft: An effective adjunct to oronasal fistula repair in patients with cleft palate. Ann Maxillofac Surg 2015; 4:158-61. [PMID: 25593864 PMCID: PMC4293835 DOI: 10.4103/2231-0746.147108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context: Oronasal fistula (ONF) following cleft palate (CP) repair are a challenging problem associated with high recurrent rates. Acellular dermal matrix allograft is an available tissue substitute. Aims: The aim of this study was to evaluate the effectiveness of acellular dermal matrix in the repair of ONF associated with CP that is recurrent or larger than 15 mm in any dimension. Settings and Design: This is a prospective study where 12 patients with repaired CP suffering from ONF of the hard palate >15 mm in diameter were included. Materials and Methods: Age ranged from 12 to 25 years. Acellular dermal matrix was firmly secured between repaired oral and nasal mucosal layers. Patients were clinically followed-up for 6 months postoperatively to assess total time for complete healing, dehiscence and/or refistulaization. Statistical Analysis Used: Fisher's exact test. Results: Acellular dermal matrix was integrated with successful fistula closure in all except 1 patient where failure of graft integration was noticed early postoperatively. In 6 patients, the oral mucosal layer showed dehiscence, through which the graft was exposed. Graft integration extended from 4 to 12 weeks postoperatively during which patients were instructed to follow a soft diet and meticulous oral hygiene measures. Conclusions: Acellular dermal matrix allografts are safe and effective adjuncts for use in closure of ONF in the hard palate that is recurrent or larger than 15 mm in any dimension.
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Transverse mucoperiosteal flap inset by rotation for cleft palate repair: technique and outcomes. Ann Plast Surg 2015; 72:S90-3. [PMID: 24691322 DOI: 10.1097/sap.0000000000000153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cleft palate is a relatively common deformity with various techniques described for its repair. Most techniques address the hard palate portion of the cleft with bilateral mucoperiosteal flaps transposed to the midline. This results in superimposed, linear closure layers directly over the cleft and may predispose the repair to oronasal fistula formation. This report details an alternative technique of flap rotation with an outcome analysis. METHODS A retrospective chart analysis was performed of all patients having undergone primary palatoplasty for cleft palate. Demographics and cleft Veau type were recorded. Postoperative speech outcomes were assessed by standardized speech evaluation performed by 2 speech language pathologists. The presence and location of oronasal fistulae was assessed and recorded by the surgeon and speech language pathologists in follow-up evaluations. RESULTS The study revealed an overall incidence of velopharyngeal insufficiency of 5.7% using this surgical technique. It also revealed a fistula rate of 8.6%. Secondary surgery has been successful in those patients in which it was indicated. Eleven (31%) patients were diagnosed with Robin sequence. CONCLUSIONS This technique demonstrates excellent early outcomes in a difficult subset of cleft patients including a high proportion of those with Pierre Robin sequence. The technique addresses the inherent disadvantages to a linear closure over the bony cleft. The variability in its design provides the surgeon another option for correction of this deformity.
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Fistula incidence after primary cleft palate repair: a systematic review of the literature. Plast Reconstr Surg 2014; 134:618e-627e. [PMID: 25357056 DOI: 10.1097/prs.0000000000000548] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The development of an oronasal fistula after primary cleft palate repair has a wide variation reported in the literature. The aim of this review is to identify the reported oronasal fistula incidence to provide a benchmark for surgical practice. METHODS A systematic review was undertaken to investigate the incidence of fistula. Multiple meta-analyses were performed to pool proportions of reported fistulae, in each data set corresponding to the continent of origin of the study, type of cleft, and techniques of cleft palate repair used. RESULTS A total of 9294 patients were included from 44 studies. The overall incidence of reported fistula was 8.6 percent (95 percent CI, 6.4 to 11.1 percent). There was no significant difference in the fistula incidence corresponding to the continent of origin of each study or the repair technique used. The incidence of fistula in cleft lip-cleft palate was 17.9 percent, which was significantly higher (p = 0.03) than in cases of cleft palate alone (5.4 percent). CONCLUSIONS Palatal fistulae were more likely to occur in cases of combined cleft lip-cleft palate, compared with cleft palate alone. The authors would recommend the prospective examination and recording of all fistulae to a standardized classification scheme. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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A Systematic Review Comparing Furlow Double-Opposing Z-Plasty and Straight-Line Intravelar Veloplasty Methods of Cleft Palate Repair. Plast Reconstr Surg 2014; 134:1014-1022. [DOI: 10.1097/prs.0000000000000637] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bykowski MR, Naran S, Winger DG, Losee JE. The Rate of Oronasal Fistula Following Primary Cleft Palate Surgery: A Meta-Analysis. Cleft Palate Craniofac J 2014; 52:e81-7. [PMID: 25322441 DOI: 10.1597/14-127] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite decades of craniofacial surgeons repairing cleft palates, there is no consensus for the rate of fistula formation following surgery. The authors present a meta-analysis of studies that reported on primary cleft palate to determine the rate of oronasal fistula and to identify risk factors for their development. METHODS A literature search for the period between 2000 and 2012 was performed. Articles were queried and strict inclusion and exclusion criteria were applied to focus on primary cleft palate repair. A meta-analysis of these data was conducted. RESULTS The meta-analysis included 11 studies, comprising 2505 children. The rate of oronasal fistula development was 4.9% (95% confidence interval, 3.8% to 6.1%). When analyzing a larger cohort, there was a significant relationship between Veau classification and the occurrence of a fistula (P < .001), with fistulae most prevalent in patients with a Veau IV cleft. The most common location for a fistula was at the soft palate-hard palate junction. One study used decellularized dermis in cleft repair with a fistula rate of 3.2%. CONCLUSIONS Using 11 studies comprising 2505 children, we find the rate of reported fistula occurrence to be 4.9%. Furthermore, patients with a Veau IV cleft are significantly more likely to develop an oronasal fistula. When fistulae do occur, they do so most often at the soft palate-hard palate junction. A deeper understanding of fistula formation will help cleft palate surgeons improve their outcomes in the operating room and will allow them to effectively communicate expectations with patients' families in the clinic.
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Reardon JB, Brustowicz KA, Marrinan EM, Mulliken JB, Padwa BL. Anatomic Severity, Midfacial Growth, and Speech Outcomes in Van der Woude/Popliteal Pterygium Syndromes Compared to Nonsyndromic Cleft Lip/Palate. Cleft Palate Craniofac J 2014; 52:676-81. [PMID: 25210863 DOI: 10.1597/14-132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To summarize the clinical characteristics and surgical and speech outcomes for patients with Van der Woude/popliteal pterygium syndromes (VWS/PPS) and to compare them with a historic cohort of patients with nonsyndromic cleft lip/cleft palate (CL/P). DESIGN Retrospective chart review. SETTING Tertiary care center. PATIENTS All patients with VWS/PPS seen at Boston Children's Hospital from 1979 to 2012: 28 patients with VWS (n = 21)/PPS (n = 7) whose mean age was 17.3 ± 10.4 years, including 18 females (64%) and 10 males (36%); 18 patients (64%) had a family history of VWS/PPS. MAIN OUTCOME MEASURES Cleft type, operative procedures, speech, and midfacial growth. Data were compared with historic cohorts of patients with nonsyndromic CL/P treated at one tertiary care center. RESULTS There were 24 patients (86%) with CP±L, Veau types I (n = 4, 17%), II (n = 4, 17%), III (n = 5, 21%), and IV (n = 11, 46%). Nine patients (38%) had palatal fistula after palatoplasty. Fourteen of 23 (61%) patients with CL/P age 5 years or older had midfacial retrusion, and 10 (43%) required a pharyngeal flap for velopharyngeal insufficiency. Fisher's exact test demonstrated higher frequencies of Veau type IV CP±L (P = .0016), bilateral CL±P (P = .0001), and complete CL±P (P < .0001) in VWS/PPS compared with nonsyndromic patients. Incidences of midfacial retrusion (P = .0001), palatal fistula (P < .0001), and need for pharyngeal flap (P = .0014) were significantly greater in patients with VWS/PPS. CONCLUSIONS Patients with VWS/PPS have more severe forms of labiopalatal clefting and higher incidences of midfacial retrusion, palatal fistula, and velopharyngeal insufficiency following primary repair as compared with nonsyndromic CL/P.
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De Agostino Biella Passos V, De Carvalho Carrara CF, Da Silva Dalben G, Costa B, Gomide MR. Prevalence, Cause, and Location of Palatal Fistula in Operated Complete Unilateral Cleft Lip and Palate: Retrospective Study. Cleft Palate Craniofac J 2014; 51:158-64. [DOI: 10.1597/11-190] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors. Design Retrospective analysis of patient records and evaluation of preoperative initial photographs. Setting Tertiary craniofacial center. Participants Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007. Interventions The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate. Main outcome measures Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated. Results Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association ( P ≤ .05) between the fistulas and initial cleft width ( P = .0003), intraoperative problems ( P = .0037), and postoperative problems ( P = .00002). Conclusions The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.
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Affiliation(s)
| | | | | | - Beatriz Costa
- Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil
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113
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A Clinical Study of Various Buccinator Musculomucosal Flaps for Palatal Fistulae Closure After Cleft Palate Surgery. J Craniofac Surg 2014; 25:e197-202. [DOI: 10.1097/scs.0000000000000411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mendonca DA, Patel KB, Skolnick GB, Woo AS. Anatomical study of the effects of five surgical maneuvers on palate movement. J Plast Reconstr Aesthet Surg 2014; 67:764-9. [PMID: 24721126 DOI: 10.1016/j.bjps.2014.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 10/25/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
The anatomy of the palate has been extensively described, with a predominant focus on palatal musculature. There are no biomechanical studies investigating the effects of surgical maneuvers on the palate to aid cleft closure. This study aims to describe the soft tissue attachments at different zones and quantify the movement following their release. Fourteen adult cadaver heads were dissected. The palates were split in the midline and five maneuvers described: Step 1, over the hard palate; Step 2, around the greater palatine pedicle; Step 3, over the palatine aponeurosis; Step 4, over the hamulus; and Step 5, resulting in a hamulus fracture. The movements across the midline at the posterior nasal spine following each maneuver were measured. The age range of the 14 heads was between 60 -75 years. Completion of steps 1 and 2 over the hard palate obtained a mean release of 2.6 and 2.0 mm, respectively. The largest movements occurred at Step 3 (5.7 mm) and Step 4 (3.5 mm), after releasing attachments at the posterior hard palate and palatine aponeurosis. Steps 3 and 4 dissections exhibited cumulative release, with a maximum movement with Step 3 (p < 0.05). Isolated fracture of the hamulus (Step 5) yielded a mean movement of 1.4 mm. Individual steps of dissection are described with respect to releasing soft tissue attachments. Medial movement of the oral mucosa is quantified with each step of dissection. The greatest release occurred with dissection overlying the palatine aponeurosis posterior to the hard/soft palate junction. Additional dissection along the hamulus (without fracture) added significantly to this release.
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Affiliation(s)
- Derick A Mendonca
- Division of Plastic Surgery, Sakra World Hospital, Bangalore 560 103, India.
| | - Kamlesh B Patel
- Cleft Palate-Craniofacial Institute, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Gary B Skolnick
- Cleft Palate-Craniofacial Institute, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Albert S Woo
- Cleft Palate-Craniofacial Institute, Washington University School of Medicine, St Louis, MO 63110, USA
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115
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Winters R, Carter JM, Givens V, St Hilaire H. Persistent oro-nasal fistula after primary cleft palate repair: minimizing the rate via a standardized protocol. Int J Pediatr Otorhinolaryngol 2014; 78:132-4. [PMID: 24315213 DOI: 10.1016/j.ijporl.2013.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/03/2013] [Accepted: 11/09/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Multiple methods are described for cleft palate repair. Similarly, a wide range of postoperative oro-nasal fistula rates are described, depending on technique and series examined. We describe long-term outcomes and fistula rates for primary cleft palate repair for a single surgeon using a standardized protocol. Furlow palatoplasty was used for clefts limited to the soft palate, and two-flap palatoplasty was used for clefts involving both the hard and soft palate. METHODS Retrospective review of prospectively gathered data. RESULTS Eighty-two patients underwent cleft palate repair within the study period. Average age at time of repair was 1.69 years (range 0.47-12.1 years), 19 patients had cleft palate as a part of a known genetic syndrome, and male:female ratio was 1.05:1. Overall fistula rate requiring repair was 5.5%, and fistula development was not significantly associated with type of cleft repair or use of AlloDerm in the repair. CONCLUSIONS A very low rate of oro-nasal fistula and good postoperative outcomes were achieved utilizing this protocol for cleft palate repair. It is effective both in isolated cleft palate, as well as in more complicated syndromic patients. It is possible that significant associations between repair technique and fistula rate exist that were not elucidated in this study as a result of the small number of oro-nasal fistulas.
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Affiliation(s)
- Ryan Winters
- Tulane University Department of Otolaryngology - Head & Neck Surgery, United States.
| | - John M Carter
- Tulane University Department of Otolaryngology - Head & Neck Surgery, United States
| | - Victoria Givens
- Louisiana State University - New Orleans School of Medicine, United States
| | - Hugo St Hilaire
- Louisiana State University Division of Plastic & Reconstructive Surgery, United States
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Woisard V, Noirrit-Esclassan E, Vandrebeck V, Al Hawat A, Galinier P, Lauwers F. Impact of obturation of palatal fistulae on speech quality and aerodynamic parameters in patients with cleft palates. Folia Phoniatr Logop 2013; 65:171-7. [PMID: 24356258 DOI: 10.1159/000355133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this prospective study was to measure nasal and oral airflow during speech, before and after obturation. PATIENTS AND METHODS Included were children aged 3-18 years with nonsyndromic clefts and palatal fistulae. The corpus used was: syllable /pi/; a sentence containing stop consonants and a nasal phoneme; and the description of a picture of a scene. Analysis criteria were: percentage of nasality; value of average flow for the explosion; perceived nasality and intelligibility; and tolerance of the proposed device. RESULTS Only 5 children were included due to the observation of an increase in the percentage of nasality after obturation. The value of average flow for the explosion increased in all patients. A decrease in perceived nasality was noted in all but 1 patient. An improvement in intelligibility was observed in 3 out of the 5 children. The tolerance of the device was good. CONCLUSION While the small number of patients studied does not permit firm conclusions concerning the efficiency of the obturation, the method described, as well as the introduction of 'speed of explosion' of stop consonants, offer new perspectives to prospectively study obturator effects on speech.
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Affiliation(s)
- Virginie Woisard
- Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Rangueil-Larrey, Toulouse, France
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Ravikumar N, GunaShekhar M, Prasad SR, Lalitha N, Raju PR, Natesh YA. Unusual foreign body in the nasal cavity of an adult with repaired cleft lip and palate. Cleft Palate Craniofac J 2013; 52:219-22. [PMID: 25714269 DOI: 10.1597/13-081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intranasal foreign bodies arising from dental clinical practice, especially in patients with cleft lip and palate (CLP) occur rarely and are very scarce in the literature. This article reports an unusual case of a dental impression material presenting as a foreign body in the nasal cavity of an adult with repaired CLP who presented for dental prosthetic rehabilitation. To our knowledge, this is only the second report presenting nasal foreign body in a cleft patient arising due to a dental impression procedure.
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118
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Vasishta SMS, Krishnan G, Rai YS, Desai A. The versatility of the tongue flap in the closure of palatal fistula. Craniomaxillofac Trauma Reconstr 2013; 5:145-60. [PMID: 23997859 DOI: 10.1055/s-0032-1313352] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/30/2011] [Indexed: 10/28/2022] Open
Abstract
Aims Tongue flaps were introduced for intraoral reconstruction by Lexer in 1909. A retrospective study was performed in the Department of Oral and Maxillofacial Surgery, S.D.M. College of Dental Sciences (Dharwad, India), to assess the use of tongue flap in closure of palatal fistula. Material and Methods A total of 40 patients treated for palatal fistulas were included in this study from the period of January 1, 2000, to January 1, 2007; fistulas present in anterior and midpalate were considered. Patients' preoperative photographs, clinical records, and preoperative speech analysis were recorded. Following completion of fistula closure, patients were assessed over 6 months to check flap viability, fistula closure, residual tongue function, aesthetics, and speech impediment. Results A total of 40 (24 male and 16 female) patients with palatal fistulas were treated with tongue flap in our study. Six patients were 4 to 6 years old, three were 7 to 10 years old, and 22 were 11 to 20 years old, which accounts for 68% of study subjects. There were nine patients 21 to 30 years old. In the early postoperative period, we encountered bleeding in one patient and sloughing in one patient. There are three recurrences, and two flaps were detached; all remaining cases showed satisfactory healing, and donor site morbidity was minimal. No speech deficits were evident. Conclusion Tongue flaps are used in cleft palate surgery because of their excellent vascularity, and the large amount of tissue that they provide has made tongue flaps particularly appropriate for the repair of large fistulas in palates scarred by previous surgery.
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Palatal fistulae: a comprehensive classification and difficulty index. J Maxillofac Oral Surg 2013; 13:305-9. [PMID: 25018605 DOI: 10.1007/s12663-013-0535-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 05/15/2013] [Indexed: 10/26/2022] Open
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.
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Gongorjav NA, Luvsandorj D, Nyanrag P, Garidhuu A, Sarah EG. Cleft palate repair in Mongolia: Modified palatoplasty vs. conventional technique. Ann Maxillofac Surg 2013; 2:131-5. [PMID: 23482408 PMCID: PMC3591054 DOI: 10.4103/2231-0746.101337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Context: Cleft palate repair is preferentially completed between 6 and 18 months of age, facilitating essential speech and language development along with swallowing and feeding reflexes, and avoiding otitis media and hearing loss. In Mongolia patients often present in early adulthood for cleft lip and/or palate management. Wider defects are associated with older age groups and have higher rates of fistula formation and wound dehiscence. These complications encouraged a modified surgical technique for improved outcomes. Aims: Objectives of this study were to compare the efficacy of three established palatoplasty techniques with our mongolian technique. Materials and Methods: A retrospective review of all palatoplasty cases, in non-syndromic cleft lip and/or palate patients, between January 1992 and November 2008 in Ulaanbaatar, Mongolia was performed. Exclusion criteria included those suffering from an acute or chronic respiratory illness at presentation or in the recovery period. We compared three established techniques with our modified technique. Outcome measures were duration of surgery, length of hospital stay and fistula rate. Statistical Analysis Used: Discrete data are reported as n (%), while continuous data are summarised as mean±SD. Differences in demographic, surgical and postoperative data were tested by independent t-test (continuous data) and Fisher's exact test (discrete data). Results: Palatoplasty was performed on 436 patients with an average age of 60 months. The modified palatoplasty technique had reduced surgical time (P value <0.01) and hospital stay (P value <0.01) and a 96% complication free wound recovery, compared with established techniques. Cleft lip and/or palate patients aged 42 months or older were more likely to be from the countryside. Conclusions: 86.9% of patients presenting for cleft palate repair had palatoplasty later than the recommended age. Geographical predilection for children older than six years, were more likely to have cleft palate repair complications. We have shown the modified palatoplasty technique is a more efficient time saving surgical procedure with lower complication rates.
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Affiliation(s)
- N Ayanga Gongorjav
- Department of Maxillofacial Surgery, Maternal and Child Health Research Centre, Ulaanbaatar, Mongolia
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Nadjmi N, Van Erum R, De Bodt M, Bronkhorst EM. Two-stage palatoplasty using a modified Furlow procedure. Int J Oral Maxillofac Surg 2013; 42:551-8. [PMID: 23433472 DOI: 10.1016/j.ijom.2012.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 11/16/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
A two-stage palatal repair using a modification of Furlow palatoplasty is presented. The authors investigate the speech outcome, fistula formation and maxillary growth. In a prospective, successive cohort study, 40 nonsyndromic patients with wide cleft palate were operated on between March 2001 and June 2006 by a single surgeon. 10 patients in the first cohort underwent a Furlow palatoplasty (control group). In 30 patients in the second cohort a unilateral myomucosal cheek flap was used in combination with a modified Furlow palatoplasty (study group). The hard palate was closed in both groups 9-12 months later. The Bzoch speech quality score was superior in the study group, and the hypernasality was significantly reduced in the study group. Overall fistula formation was 0%. At the time of hard palate reconstruction palatal cleft width was significantly reduced. Relative short-term follow up of maxillary growth was excellent. There were no postoperative haematomas, infections, or episodes of airway obstruction. This technique is particularly encouraging, because of better speech outcome, absence of raw surfaces on the soft palate, no fistula formation, and good maxillary growth. Further follow-up is necessary to determine the long-term effects on facial development.
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Affiliation(s)
- N Nadjmi
- OMFS, University Hospital Antwerp (UA), Belgium.
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122
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Harish PV, Bhojaraju N, Sowmya GR, Gangaiah M. Management of Oro-Nasal Fistula Using Andrew's Bridge: A Case Report. J Indian Prosthodont Soc 2012; 14:317-20. [PMID: 25183920 DOI: 10.1007/s13191-012-0233-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022] Open
Abstract
Oro-nasal fistula is the most common complication following the surgical closure of the cleft palate. Retention is the paramount factor in the successful prosthodontic habilitation of cleft palate patients. Various precision attachments have provided us with the opportunity to make the prosthesis fixed removable type; giving a double advantage to the patient i.e. comfort through fixed type and easy maintenance through removal type. This case report describes a case of oro-nasal fistula habilitated with an obturator attached to Andrew's bridge, which had good retention and esthetics.
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Affiliation(s)
- P V Harish
- Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Kumbalgodu, Mysore Road, Bangalore, 560060 India
| | - Nandakishore Bhojaraju
- Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Kumbalgodu, Mysore Road, Bangalore, 560060 India
| | - G R Sowmya
- Department of Orthodontics, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, India
| | - Makam Gangaiah
- Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Kumbalgodu, Mysore Road, Bangalore, 560060 India
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123
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Surgical management of a rare variant of submucous cleft palate. J Craniofac Surg 2012; 23:e642-3. [PMID: 23172510 DOI: 10.1097/scs.0b013e3182710287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A submucous cleft is a palatal defect that is bridged over by mucosa; such a defect has been recognized for many years. A small portion of all cleft palate defects shows this phenomenon, but the cryptic nature of the lesion and the frequent failure to include it in the differential diagnosis of speech problems may make the defect's discovery a belated one. This report is a case of incomplete submucous cleft palate and its management.
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124
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Khanna S, Dagum AB. Waltzing a Facial Artery Musculomucosal Flap to Salvage a Recurrent Palatal Fistula. Cleft Palate Craniofac J 2012; 49:750-2. [DOI: 10.1597/11-040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Closure of a palatal fistula, especially after multiple recurrences, remains a complex reconstructive problem. Herein, salvage of a recurrent palatal fistula after a facial artery musculomucosal flap (FAMM) flap by use of the traditional waltzing (jumping, migration) principle of tubed pedicle flaps is presented and the principles are discussed.
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Affiliation(s)
- Shachika Khanna
- Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Alexander B. Dagum
- Cleft Palate Craniofacial Center, State University of New York, Stony Brook, New York
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125
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Neumann S, Romonath R. Application of the International Classification of Functioning, Disability, and Health–Children and Youth Version (ICF-CY) to Cleft Lip and Palate. Cleft Palate Craniofac J 2012; 49:325-46. [DOI: 10.1597/10-145] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective In recent health policy discussions, the World Health Organization has urged member states to implement the International Classification of Functioning, Disability, and Health: Children and Youth Version in their clinical practice and research. The purpose of this study was to identify codes from the International Classification of Functioning, Disability, and Health: Children and Youth Version relevant for use among children with cleft lip and/or palate, thereby highlighting the potential value of these codes for interprofessional cleft palate-craniofacial teams. Design The scope of recent published research in the area of cleft lip and/or palate was reviewed and compared with meaningful terms identified from the International Classification of Functioning, Disability, and Health: Children and Youth Version. In a five-step procedure, a consensus-based list of terms was developed that was linked separately to International Classification of Functioning, Disability, and Health: Children and Youth Version categories and codes. This provided a first draft of a core set for use in the cleft lip and/or palate field. Conclusions Adopting International Classification of Functioning, Disability, and Health: Children and Youth Version domains in cleft lip and/or palate may aid experts in identifying appropriate starting points for assessment, counseling, and therapy. When used as a clinical tool, it encourages health care professionals to go beyond treatment and outcome perspectives that are focused solely on the child and to include the children's environment and their familial/societal context. In order to establish improved, evidence-based interdisciplinary treatments for children with cleft lip and/or palate, more studies are needed that seek to identify all the influencing conditions of activities, children's participation, and barriers/facilitators in their environments.
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Affiliation(s)
- Sandra Neumann
- Pedagogics and Therapy of Speech and Language Disorders, University of Cologne, Germany, and Research Fellow, Cognitive Neurology Section, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Germany
| | - Roswitha Romonath
- Pedagogics and Therapy of Speech and Language Disorders, University of Cologne, Germany
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126
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Abdel-Aziz M, El-Hoshy H, Naguib N, Reda R. Furlow technique for treatment of soft palate fistula. Int J Pediatr Otorhinolaryngol 2012; 76:52-6. [PMID: 22019153 DOI: 10.1016/j.ijporl.2011.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 09/22/2011] [Accepted: 09/24/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fistula of the palate is a common complication of palatoplasty, it leads to nasal regurgitation of fluids and hypernasality of speech. Its treatment is technically difficult due to paucity and fibrosis of palatal tissues. The aim of this study was to evaluate the efficacy of closure of soft palate fistula by using Furlow double opposing Z-palatoplasty. METHODS Nineteen patients were subjected for repair of their soft palate fistulas using Furlow Z-plasty. Pre and postoperative speech analysis using auditory perceptual assessment, measurement of nasalance score using nasometric assessment, and measurement of velar movement using flexible nasopharyngoscopy were done. RESULTS All cases showed complete closure of their fistulas at first attempt, with no operative or postoperative complications. Recurrence was not recorded in any case after a follow up period of at least 12 months. Significant improvement of speech quality and nasalance score was achieved. Flexible nasopharyngoscopy showed postoperative increase in velar movement which was not significant relative to the preoperative records. CONCLUSIONS Treatment of soft palate fistula by using Furlow technique is an effective method as a primary treatment with a high success rate and a good functional outcome.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Egypt.
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127
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González-Sánchez JG, Jiménez-Barragán K. Cierre de fístulas nasopalatinas recurrentes con plasma rico en factores de crecimiento en pacientes con paladar hendido. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:448-53. [DOI: 10.1016/j.otorri.2011.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 10/17/2022]
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129
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Abstract
The primary goal of palatoplasty is to allow normal speech through the correction of velopharyngeal incompetence. Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to postoperative fistula formation. Fistulas may in turn contribute to velopharyngeal incompetence. Reported fistula rates vary widely, ranging from 0% to greater than 70%; recurrence rates after attempted repair approach 65% in some series. These lesions therefore represent a significant clinical burden. Acellular dermal matrix materials have been introduced into various phases of palatoplasty as a strategy to augment repairs and minimize postoperative fistula formation, as well as repair fistulas when they do occur. In this article, the authors review the existing literature regarding acellular dermal matrix in palatoplasty and describe their own algorithm and results for primary and secondary palatoplasty in which acellular dermal matrix plays a central role.
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Affiliation(s)
- Joseph E Losee
- Division of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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130
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Murthy J. Descriptive study of management of palatal fistula in one hundred and ninety-four cleft individuals. Indian J Plast Surg 2011; 44:41-6. [PMID: 21713216 PMCID: PMC3111121 DOI: 10.4103/0970-0358.81447] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Palatal fistula is a significant complication following cleft palate repair. The guidelines of management of the palatal fistula is dependent on the type of cleft, site of fistula, condition of surrounding tissue and associated problem. We studied the management and outcome of 194 cleft palate fistula in our institute. Design: We present the descriptive hospital-based study of management of palatal fistula in 194 cleft patients. We have excluded all the syndromic children and children whose anterior palate was not operated as per protocol. Settings: Of 194 cleft palate fistula, 37 had palate repair in our hospital and 157 were refereed with fistula following palate repair.The patients were evaluated by interdisciplinary team and plan of management was decided. Result: Various parameters like types of cleft, site of fistula and management of fistula were studied in all the patients. Fifty-two percent were in unilateral CLP and 30% in bilateral CLP because unilateral CLP is the commonest type of cleft. Postalveolar and hard palate region contributing to 67% of all fistulae, followed by junctional in (9%). Seventy-two percent of fistula were amenable for repair by local available tissue, 28% needed tongue flap due to shortage of tissue. Minor numbers have failure of procedure for fistula closure needing further management. Conclusions: This descriptive study present analysis of management of fistula in our institute. It also reinforces that patient with bilateral cleft lip and palate more likely to have shortage of local tissue needing the local flaps like tongue flap compare to other cleft types. The surgical management of fistula can be combined to tackle the associated problems.
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Affiliation(s)
- Jyotsna Murthy
- Department of Plastic Surgery, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
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131
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Eberlinc A, Koželj V. Incidence of residual oronasal fistulas: a 20-year experience. Cleft Palate Craniofac J 2011; 49:643-8. [PMID: 21740163 DOI: 10.1597/10-146] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the incidence and most frequent anatomical locations of residual oronasal fistulas in children with different types of clefts who were treated at the University Department of Maxillofacial and Oral Surgery in Ljubljana. DESIGN Retrospective analysis of 857 consecutive patients with cleft born between 1984 and 2003. RESULTS After primary surgical repair, 33 out of 857 (3.9%) children had residual oronasal fistulas. The incidence of clinically significant fistulas that required surgical repair was 17 of 857 (2.0%). In children with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), or isolated cleft palate (CP), the incidence of palatal fistulas was 23 of 644 (3.6%). Of these palatal fistulas, 12 (1.9%) were clinically significant. Oronasal fistulas were most frequently found in children with BCLP (9 of 88, 10.2%), followed by UCLP (12 of 215, 5.6%) and CP (12 of 341, 3.5%). No fistulas were found in children with unilateral cleft lip and alveolar ridge. In 10 cases (30.3%), the oronasal fistula remained in the alveolar ridge, in 11 cases (33.3%) in the anterior part of the hard palate, and in 11 cases (33.3%) at the junction of the hard and soft palates. In one case (3%), the records were lost. CONCLUSION The low incidence of oronasal fistulas is the result of a surgical technique and tensionless suturing, followed by a two-layer closure, two-stage palate repair in BCLP and UCLP patients, and preoperative orthopedics in UCLP cases.
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Affiliation(s)
- Andreja Eberlinc
- Department of Maxillofacial and Oral Surgery, University Hospital Ljubljana, Ljubljana, Slovenia.
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132
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The use of buccal fat pad (BFP) as a pedicled graft in cleft palate surgery. Int J Oral Maxillofac Surg 2011; 40:685-9. [DOI: 10.1016/j.ijom.2011.02.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 12/29/2010] [Accepted: 02/22/2011] [Indexed: 11/23/2022]
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Bénateau H, Traoré H, Gilliot B, Taupin A, Ory L, Guillou Jamard MR, Labbé D, Compère JF. [Repair of palatal fistulae in cleft patients]. ACTA ACUST UNITED AC 2011; 112:139-44. [PMID: 21481901 DOI: 10.1016/j.stomax.2011.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 02/24/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Treatment of oronasal fistulae in cleft patients remains a surgical challenge because of its high failure rate. The authors report the results of an aggressive surgical technique using the total elevation of palatal mucoperiosteum, even for small fistulae. METHODS This approach was used on twelve consecutive patients, from five to 33 years of age, presenting with a Pittsburgh classification type IV palatal fistulae. The surgical procedure was total elevation of the hard palate mucoperiosteum starting from the dental sulcus combined with sealed double layer sutures. Clinical and photographical control was made at least 6 months after to detect a possible relapse. RESULTS The success rate was 100%. No relapsing fistula was observed with follow-up ranging from 6 to 36 months. DISCUSSION This technique allows wide exposure and safe closure of the nasal layer. It is simple and leaves no raw bone surface exposed and no additional scar. The authors think it can be used in all type IV fistulae less than 1cm wide. Several other surgical techniques have been described to close palatal fistulae: local turnover flaps, pedicled flaps from adjacent oral tissue, tongue flaps, tissue expansion, and even free flaps. Obturator prostheses have also been used. The technique we report, even if more aggressive, seems to be more reliable with fewer relapse and sequelae.
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Affiliation(s)
- H Bénateau
- Service de chirurgie maxillo-faciale, CHU de Caen, avenue de la Cote-de-Nacre, 14033 Caen cedex, France.
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Abdel-Aziz M. V-Y two-layer repair for oronasal fistula of hard palate. Int J Pediatr Otorhinolaryngol 2010; 74:1054-7. [PMID: 20591506 DOI: 10.1016/j.ijporl.2010.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/03/2010] [Accepted: 06/03/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Oronasal fistula represents a functional problem after cleft palate repair; its closure is technically difficult with a high recurrence rate after primary treatment. The aim of this study was to evaluate the efficacy of closure of oronasal fistula using 2 layers of oral mucoperiosteum in a V-Y manner. METHODS Fourteen patients were subjected for repair of their oronasal fistulas using 2 layers; the first is the oral mucoperiosteum that is elevated and inverted to close the nasal side as a hinge flap, and the second is also the oral mucoperiosteum that is elevated and sutured in a V-Y manner to close the oral side. RESULTS In all cases, the fistula was completely closed at first attempt, no cases developed operative or postoperative complications. Recurrence with not recorded in any case after a follow-up period of at least 12 months. CONCLUSION Closure of oronasal fistula of the hard palate that may develop after cleft palate repair using a two-layer closure in V-Y manner is an easy and ideal method with a high success rate.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt.
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135
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A successful algorithm for limiting postoperative fistulae following palatal procedures in the patient with orofacial clefting. Plast Reconstr Surg 2010; 122:544-554. [PMID: 18626373 DOI: 10.1097/prs.0b013e31817d6223] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Palatal procedures include (1) primary palatoplasty, (2) oronasal fistulas repair, and (3) secondary palatoplasty for velopharyngeal insufficiency. Any time a palatal procedure is performed, postoperative fistulas remain potential consequences. Presented here is a successful algorithm for performing palatal procedures and decreasing the rate of postoperative fistulas in a large, single-surgeon, consecutive series. METHODS A retrospective review of all consecutive palatal procedures performed between 2002 and 2006 including (1) primary palatoplasty, (2) oronasal fistulas repair, and (3) secondary palatoplasty for velopharyngeal insufficiency was performed. Cleft Veau type, surgical technique, and outcomes are reviewed. The algorithm included (1) relaxing incisions, (2) complete intravelar veloplasty, (3) total release of the tensor tendon, (4) dissection of the neurovascular bundle with optional osteotomy of the foramen, and (5) incorporation of acellular dermal matrix to achieve complete nasal lining reconstruction. RESULTS Two hundred sixty-eight palatal procedures were performed: (1) 132 primary Furlow palatoplasties yielding one symptomatic post-Furlow palatoplasty fistula (0.76 percent) (acellular dermal matrix was used in 39.4 percent of primary palatoplasties); (2) 55 oronasal fistula repairs yielding two symptomatic postoperative fistulas (3.6 percent) (acellular dermal matrix was used in 90.9 percent of fistula repairs); and (3) 81 secondary palatoplasties for velopharyngeal insufficiency resulting in no postoperative fistulas. Acellular dermal matrix was used in 14.8 percent of secondary palatoplasties for velopharyngeal insufficiency. No recommendations for speech surgery followed palatoplasty. CONCLUSIONS Using the proposed algorithm in this single-surgeon consecutive series of 268 cases, the authors achieved the lowest reported incidence of postoperative fistulas in all forms of palatal procedures, including the lowest incidence (0.76 percent) of symptomatic palatal fistulas following primary Furlow palatoplasty.
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Sader R, Seitz O, Kuttenberger J. Resorbable collagen membrane in surgical repair of fistula following palatoplasty in nonsyndromic cleft palate. Int J Oral Maxillofac Surg 2010; 39:497-9. [PMID: 20227244 DOI: 10.1016/j.ijom.2010.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/24/2009] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
Treatment of palato-nasal fistula following primary palatoplasty in patients with nonsyndromic cleft palate is often complicated by recurrence. The authors have tested the feasibility of a surgical technique adding a resorbable collagen membrane at the bony edge of the fistula and report the outcome in the first 14 patients in an open, non-comparative, preliminary investigation. The procedure was well tolerated by all patients, with no relapses during follow up ranging from 4 to 12 months.
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Affiliation(s)
- R Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt am Main, Frankfurt, Germany.
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137
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Abstract
Oronasal fistula formation is a recalcitrant complication following palatoplasty, resulting in nasal emission during speech and deglutition. We review our series to identify factors associated with fistula incidence. A retrospective review of all children with nonsyndromic cleft palate who underwent 2-flap palatoplasty by the senior author from July 1983 to August 2004, was performed. Patient demographics, cleft characteristics, and operative techniques were recorded for each patient. The incidence rates of fistula, pharyngeal flap, and reoperation were used as primary outcomes. Statistical comparisons of frequencies were performed using Fisher exact test. Comparisons of means were performed using chi2 analysis. A total of 332 consecutive children met inclusion criteria. Mean age at palatoplasty was 10.8 months, and mean follow-up was 74.1 months. Eight children (2.4%) were found to have fistulae postoperatively, ranging in size from 2 to 15 mm. Four palatal fistulas occurred in the soft palate, 2 at the junction of the hard and soft palate, 1 in the hard palate, and 1 at the incisive foramen. Symptomatic nasal emission requiring reoperation occurred in 5 children. Two of these 5 children required a second operation to achieve fistula closure. Forty pharyngeal flaps were required for correction of velopharyngeal incompetence (12.0%). Two-flap palatoplasty remains a highly successful technique for closure of a variety of palatal clefts, with low fistula incidence. Surgical technique and experience are factors associated with low fistula incidence.
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139
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Abdel-Aziz M. The use of buccal flap in the closure of posterior post-palatoplasty fistula. Int J Pediatr Otorhinolaryngol 2008; 72:1657-61. [PMID: 18814922 DOI: 10.1016/j.ijporl.2008.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 07/30/2008] [Accepted: 07/30/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Palatal fistulation is a common complication after cleft palate repair, it could occur at any site along the line of cleft closure. Many techniques have been proposed for its repair. However, the incidence of recurrence after initial fistula closure is high. The aim of this study is to evaluate the efficacy of closure of posterior palatal fistula using buccal myomucosal flap. METHOD Fifteen cases with posterior palatal fistulas - after cleft palate repair - were included in this study. Their fistulas were closed in two-layers; an oral mucoperiosteum hinge flap to reconstruct the nasal side and a buccal myomucosal flap from the inner surface of the cheek to reconstruct the oral side. Follow-up was carried out for 1 year. RESULTS The fistulas were completely closed in all cases (100%) with no failure or recurrence. This was a single-stage operation in all cases, with no need for further procedure to divide the pedicle of the flap. CONCLUSIONS Closure of posterior palatal fistula using buccal myomucosal flap in addition to mucoperiosteal flap is a useful method with high success rate and no morbidity.
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Affiliation(s)
- Mosaad Abdel-Aziz
- Department of Otolaryngology, Faculty of Medicine, Cairo University, Egypt.
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