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Cleft Oronasal Fistula: A Review of Treatment Results and A Surgical Management Algorithm Proposal

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Author(s): Enrina Diah | Lun-Jou Lo | Claudia Yun | Ruby Wang | Luh K. Wahyuni | Yu-Ray Chen

Journal: Chang Gung Medical Journal
ISSN 2072-0939

Volume: 30;
Issue: 06;
Start page: 529;
Date: 2007;
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Keywords: oronasal fistula | cleft palate | outcome assessment | velopharyngeal function

ABSTRACT
Background: Oronasal fistulas (ONF) following cleft palate repair are commonly encounteredand remain a challenging problem. With reported recurrence ratesbetween 33% and 37%, this urges us to critically evaluate the current treatmentand propose a surgical management protocol.Methods: A retrospective study of patients treated for ONF by a single surgeonbetween 1995 and 2005 was performed. Data regarding cleft type, age atpalate repair, complications, location and size of fistula, tissue condition, surgicaltechnique employed, and success rate were gathered.Results: There were 64 patients (33 male and 31 female), and 44% of them had bilateralcleft lip and palate. Hypernasality and regurgitation were the major presentingsymptoms of these patients with ONF. Fistulas mostly occurred inthe hard palate area (53.1%). Severe scarring surrounding the ONF wasreported in 31.2% of patients. Local flap and two-flap palatoplasty were themost common techniques (62.5%) used for closure of the ONF. Twenty-fivepercent of patients needed more than one repair to close the fistula. However,the overall success rate of closure was high (90.5%). Velopharyngeal (VP)function was significantly improved: only 26.8% of patients had adequateVP function before ONF closure and 64.3% patients had adequate VP functionafter ONF closure. However, the VP function of twenty patientsremained inadequate or marginal.Conclusions: A high success rate was achieved for closure of cleft ONF, although a certainpercentage of patients required re-operation. Multiple fistulas and severelyscarred palates made closure difficult. Successful closure of a fistulaimproved VP function but VP surgery was still indicated in certain patients.Based on the findings, an algorithm for management of cleft ONF was proposed.

Tango Jona
Tangokurs Rapperswil-Jona

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