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The aim of this study was to compare the postoperative clinical and functional outcomes of palatoplasty with three soft palate cleft repairs and analyse the factors potentially impacting these outcomes. A retrospective analysis was conducted on a consecutive series of 337 patients who underwent primary cleft palate repair by palatoplasty modified with either Furlow Z-plasty (P-FZP, n = 77), intravelar veloplasty (P-IVV, n = 110), or combined intravelar veloplasty–Furlow Z-plasty (P-IVV-FZP, n = 150). The postoperative outcomes evaluated included wound healing (complete closure/fistula) and velopharyngeal function. Demographic and surgical data were analysed using both univariate and multivariate analysis. There was no significant difference between the groups with regard to the sex distribution, age at repair, cleft width, cleft type, or follow-up duration. However, relaxing incisions were significantly more common with P-FZP (26.0%) and P-IVV (29.1%) compared to P-IVV-FZP (10%) (P = 0.002 and <0.001, respectively). The complete wound closure rate was significantly higher with P-IVV-FZP (97.3%) compared to P-FZP (88.3%) (P = 0.012) and P-IVV (90%) (P = 0.015). The normal velopharyngeal function rate was comparable for P-IVV-FZP (86.7%) and P-FZP (83.1%), and both rates were significantly better than the rate with P-IVV (73.6%) (P = 0.039 and 0.029, respectively). The cleft type and width were identified as factors influencing postoperative outcomes. In conclusion, it may be appropriate to prioritize the palatoplasty with combined intravelar veloplasty–Furlow Z-plasty whenever feasible. [ABSTRACT FROM AUTHOR]

Background: Oroantral fistula (OAF) involves pathological, epithelialized, and unnatural communication between the maxillary sinus and oral cavity. Recently, functional endoscopic sinus surgery has provided minimally invasive treatment options with fewer postoperative complications. The aim of the study was to evaluate the one-stage endoscopic middle meatal antrostomy (EMMA) technique with the application of a platelet-rich fibrin membrane (PRF) for OAF closure and maxillary sinusitis relief. Patients and methods: Patients who suffered from OAF with odontogenic sinusitis were included in this study. Complete excision of the epithelial tract and any necrotic tissue was performed with proper curettage. Then, EMMA was performed with simultaneous closure of the OAF by the application of PRF membranes that were fixed by sutures and covered with an acrylic splint. Patients were clinically evaluated for OAF closure, pain level, and symptom relief. Additionally, the size of the bone defect was measured with the aid of computed tomography (CT) preoperatively and after 24 weeks postoperatively. Results: This study included nine eligible patients with a mean age of 38 years. The data were collected, tabulated, and statistically analyzed. Soft tissue healing and bone formation occurred in all patients who achieved maxillary sinusitis relief without any complications. Additionally, pain was significantly lower on the 7th postoperative day than on the 1st postoperative day, according to the statistical analysis of the results (p <.001). Conclusions: One-stage EMMA with the application of PRF membranes and acrylic splint represents a reliable alternative technique for OAF closure and maxillary sinusitis relief that is associated with a lower incidence of complications and minimal postoperative pain. Trial registration: The trial was registered on 28/02/2024, at clinicaltrials.gov (ID: NCT06281873). [ABSTRACT FROM AUTHOR]

Objectives: to audit the surgical management of infants born with non-syndromic cleft lip and palate (CLP) at an Australian cleft unit in a large tertiary paediatric hospital Design: Retrospective cohort study. Setting: A tertiary Cleft centre. Patients: 193 infants born with non-syndromic CLP were referred to the centre and underwent primary repair of their CLP between 2009 and 2020. Main Outcome Measures: (1) The timing and surgical repairs performed; (2) the frequency of postoperative complications; (3) the frequency of secondary Cleft surgery; and (4) the total Cleft-related operations performed for infants born with CLP. Results: Four different surgical repair techniques were performed by six surgeons, and postoperative complications were uncommon (n = 14). Rates of oronasal fistula surgery (10.5% at five years of age; 14.3% at eight years of age) and velopharyngeal insufficiency surgery (8.7% at five years of age; 14.3% at eight years of age) were not significantly different across the surgical repair groups (p-value >0.05) and were comparable to international Cleft centres. Children underwent an average of four operative procedures in this audit period, including primary Cleft repair, ear, nose and throat surgery, and dental care. Surgery for managing Eustachian tube dysfunction was the most common surgical intervention following primary Cleft repair. Conclusions: Children born with non-syndromic CLP have a high early operative burden, with outcomes similar across the spectrum of techniques and surgeons. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations. Design: Cross-sectional survey study. Participants: Participants in an international webinar that focused on palatal fistula treatment were included. Intervention: Participants were presented with a survey pre- and post-webinar. Main outcomes: Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system. Results: A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system. Conclusions: This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas. [ABSTRACT FROM AUTHOR]

Objective : To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek). Design : Retrospective cohort study. Setting : Tertiary Children's Hospital. Patients : All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded. Main outcome measures: Results of the primary surgery, ear–nose–throat interventions, maxillo-facial surgery and final phonatory results. Results : Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13). Conclusions : This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty. [ABSTRACT FROM AUTHOR]

Palatal fistulas are a pathological condition where there is a connection between the nasal area and the oral cavity, being one of the most frequent complications in cleft palate surgery. Palatal fistulas can cause esthetic defects and functional alterations in both feeding and speech of patients. Anterior palatal fistulas are the least common but represent a great surgical challenge for the surgeon because of their location and poor amount of tissue for closure. The purpose of this article is to present a novel technique of performing an upper lip myomucosal rotation flap for the closure of an anterior fistula, taking advantage of the labial tissue for a tension-free suture in the area of the fistula. Our technique allowed an adequate management of the fistula with low morbidity and without flap necrosis, proposing it as a useful technique for the closure of anterior fistulas.

Palatal fistulae are a recognised complication in individuals who have undergone surgical repair of a cleft palate, however, congenital or idiopathic palatal fistulae are rare. This report discusses the presentation and treatment of a 16-year-old female with a submucous cleft palate, who presented with a recent onset change in speech and evidence of a new palatal fistula. There was no history of recent infection or known trauma, and the patient had not undergone any previous palatal surgery. This report discusses the clinical presentation, recommended management and relevant literature for this rare phenomenon. [ABSTRACT FROM AUTHOR]

Objective : Palatal fistulae are challenging complications following cleft palate repair. The addition of acellular dermal matrix (ADM) to cleft palate repair has been shown to reduce fistula formation in previous studies. The use of autologous dermal graft has all the structural advantages of ADM, has less rejection and immunogenic potential, and is cost effective. Design : A prospective study. Participants : Patients with Group II and III cleft palate (Nagpur Classification) without prior intervention for palatal repair in the Department of Plastic Surgery at PGIMER from January 2020 till June 2021. Intervention : The addition of autologous dermal graft for palatoplasty. Main outcome : Outcome of the study was fistula development or exposure of dermal graft. Results : Autologous dermal graft was harvested of average dimension of 8.73 cm2 (range 5.25-18 cm2) from groin region. Sixteen patients were included in the study. Among them, 2 patients (12.5%) developed postoperative fistula (Type III &V Pittsburgh Classification). Conclusion : Our study showed that the rates of postoperative fistula formation are comparable with prior literature using artificial dermal matrices. [ABSTRACT FROM AUTHOR]

Background: This study characterizes the potential loss of velar length in patients with a wide cleft and rescue of this loss of domain by local flap reconstruction, providing anatomic evidence in support of primary lengthening of the soft palate during palatoplasty. Methods: A retrospective review was conducted of all patients with a cleft palate at least 10mm in width, who underwent primary palatoplasty with a buccal flap prior to 18 months of age over a 2-year period. All patients underwent primary palatoplasty with horizontal transection of the nasal mucosa, which was performed after nasal mucosa repair, but prior to muscular reconstruction. The resulting palatal lengthening was measured and the mucosal defect was reconstructed with a buccal flap. Results: Of the 22 patients included, 3 (13.6%) had a history of Pierre Robin sequence, and 5 (22.7%) had an associated syndrome. No patients had a Veau I cleft, 7 (31.8%) had a Veau II, 12 (54.5%) had a Veau III, and 3 had (13.6%) a Veau IV cleft. All patients had a right buccal flap during primary palatoplasty. The mean cleft width at the posterior nasal spine was 10.6 ± 2.82mm, and mean lengthening of the velum after horizontal transection of the nasal mucosa closure was 10.5 ± 2.23mm. There were 2 (9.1%) fistulas, 1 (4.5%) wound dehiscence, 1 (4.5%) 30-day readmission, and no bleeding complications. Conclusions: Patients with a wide cleft palate have a potential loss of 1cm velar length. The buccal flap can rescue the loss of domain in palatal length, and potentially improve palatal excursion. [ABSTRACT FROM AUTHOR]

Purpose: A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency. Methods: A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction. Results: Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, P <.001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, P =.757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤ P ≤.975). Conclusions: A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction. [ABSTRACT FROM AUTHOR]

Palatal fistulas are a pathological condition where there is a connection between the nasal area and the oral cavity, being one of the most frequent complications in cleft palate surgery. Palatal fistulas can cause esthetic defects and functional alterations in both feeding and speech of patients. Anterior palatal fistulas are the least common but represent a great surgical challenge for the surgeon because of their location and poor amount of tissue for closure. The purpose of this article is to present a novel technique of performing an upper lip myomucosal rotation flap for the closure of an anterior fistula, taking advantage of the labial tissue for a tension‑free suture in the area of the fistula. Our technique allowed an adequate management of the fistula with low morbidity and without flap necrosis, proposing it as a useful technique for the closure of anterior fistulas. [ABSTRACT FROM AUTHOR]

The ultimate goal of cleft palate repair is to achieve an intact palate with the separation of the oral and nasal cavities. However, some patients develop an oronasal fistula in the secondary palate after palatoplasty. Postoperatively, a secondary palatal oronasal fistula may develop, leading to functional problems. In this study, we describe a patient with recurrent oronasal fistula and alveolar cleft with multiple failed previous reconstructions at another clinic. The oronasal fistula and alveolar cleft were repaired using a tongue flap and an iliac bone graft, respectively. The patient demonstrated excellent clinical progress with no recurrence of the oronasal fistula at the 1-year follow-up. [ABSTRACT FROM AUTHOR]

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Dermoid cysts and epidermoid cysts in the floor of the mouth are rare in the pediatric age group. In this case report, we have discussed the presentation, management, and literature review of a 6-month-old female child presenting with both dermoid and epidermoid cysts in the floor of the mouth with an orocutaneous fistula. [ABSTRACT FROM AUTHOR]

Introduction: Data mining techniques expand access to important information for the decision-making process during health care. The objective the study proposes using data mining techniques to identify variables (surgical treatment protocols, patient characteristics, post-surgical complications) associated with fistulas after primary palatoplasty in patients with unilateral transforamen incisor cleft (UTIC). Method: A data set of 222 patients with UTIC without syndromes, operated by four surgeons with Furlow’s or von Langenbeck’s primary palatoplasty techniques, was analyzed for this study. Two models for detecting the outcome of surgery were induced using data mining techniques (Decision Tree and Apriori). Results: Five rules were selected from a decision tree pointing to some variables as predictors of fistulas associated with primary palatoplasty: infection, cough, hypernasality, and surgeon. Analysis of the model indicates that it correctly classifies 95.9% of occurrences between the absence and presence of fistulas. The second model indicates that the absence of post-surgical complications (infection and fever) and normal speech results (absent hypernasality, without suggestive of velopharyngeal dysfunction) are related to the absence of fistulas. Regarding surgical procedures, the Furlow technique and the Vomer flap were more frequent in patients with fistulas. Conclusion: Data mining techniques, as applied in the present study, pointed to infection and cough, hypernasality, and surgeon and surgical techniques as predictors of fistulas related to primary palatoplasty.

The mouth mirror is an essential tool in the dental armamentarium. Among its many functions, the most significant is being able to visualize aspects of the oral cavity that are not accessible visually with an appropriate operator posture. Various mouth mirrors are available and can differ in their design, head size and reflective surface. While in use, clinicians may encounter multiple circumstances that can hamper the quality of the reflected image. This in turn can negatively influence the diagnosis and treatment delivered. Hence, the purpose of this Technique Tip is to provide information on various designs of mouth mirrors as well as to provide solutions to counter the challenges associated with the use of mouth mirrors. Clinical relevance: Sharp, bright, reflected images may be provided for dental clinicians using simple methods and other equipment associated with the mouth mirror. [ABSTRACT FROM AUTHOR]

In some cases of extraction of upper third molars, when the dental roots are close to the maxillary sinus, oroantral communication may occur, characterized by the contact of the maxillary sinus with the oral cavity, causing unpleasant symptoms to the patient. This work aims to report a clinical case of closure of oroantral communication with a Bichat ball. Female patient, 48 years old, attended Clínica Sorrisos e Cia, in the municipality of Lagarto, State of Sergipe, presenting an oroantral communication on the right side of the maxilla resulting from an extraction of element 16. In view of the clinical condition of the patient, it was ordered a panoramic radiograph. After physical examination, radiographic examination and symptomatological history of the patient, oroantral communication was diagnosed. In this way, the cleaning of the maxillary sinus was carried out, in order to remove inflammatory by-products, followed by exposure and mobilization of the Bichat ball, followed by suturing it around the mucosal lesion and suturing the mucosa over the Bichat ball, using absorbable suture. It is concluded that it is a low cost, safe, and efficient technique, benefiting a satisfactory result for the patient, thus remedying the complaints. [ABSTRACT FROM AUTHOR]

Recurrent oronasal fistula closure is a challenging phenomenon that has been managed with many surgical or flap techniques, such as local, regional, and distant flaps, with various modifications. Despite these options, the ideal method to repair this kind of chronic fistula has not yet been established. It is difficult to repair because recurrent surgical repairs or interventions cause this region to become more fibrotic with less vascular tissue, which considerably reduces the likelihood of closing this kind of fistula. For this reason, surgeons and researchers continue to work to overcome these obstacles by using more regional, vascular, and neighboring tissue. Classic cleft palate repair techniques use double-layered, nasal, and oral side closure and even a three-layered technique (e.g. plus levator veli palatini and tensor veli palatini muscular repair) in the soft palate region. Hence, we used partial orbicularis oris muscle with enough vascular supply to repair the nasal side and cheek mucosal flap to repair the oral side as a double-layered repair technique. Two years later, during routine patient follow-up, no complications were identified, and the patient’s satisfaction with this treatment was acceptable. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the effect of honey or saline mouth bath for wound care on the rate of re-epithelisation of the lateral palatal defects and occurrence of early postoperative complications following palatoplasty. Methodology: This was a prospective randomized study on participants with non-syndromic cleft palate conducted at a tertiary health institution in Lagos, Nigeria. The test group received oral honey drops for post-operative care for an initial period of two weeks post-surgery, while the control group had regular oral toileting using a warm saline solution. The primary outcome was epithelisation of lateral palatal defect at 2- and 4-weeks post repair. Descriptive and comparative statistics were computed, and the p -value was set at <0.05. Results: Fifty participants were recruited into the study, 24 in the Test group and 26 in the Control group. The frequency of occurrence of oronasal fistula in the Test group was 4.0% while in the Control group was 10.0%, however, this was not statistically significant. Complete epithelisation of the lateral palatal defect was clinically observed in 66.7% of the participants in the Test group at 2 weeks post-operation, while only 38.5% of participants in the Control group had clinically observed complete epithelisation at the same time point (β = 1.70, p =.035, 95% CI 1.122–26.533). At four weeks, all wounds had epithelised irrespective of the study group. Conclusion: The application of honey appears to aid earlier epithelization of palatal surgical wounds following cleft palate repair and reduced the incidence of palatal fistula. [ABSTRACT FROM AUTHOR]

Oronasal fistula following cleft palate repair is a considerable complication with a recurrence rate of 33% to 37% and remains a challenging problem for surgeons. Furthermore, many patients have undergone several operations and experienced scar problems and other forms of morbidity. Therefore, we report a multilayered technique for oronasal fistula closure using an endoscopic nasal inferior turbinate composite graft with a palatal advance flap. This will increase the success rate after closure of small-sized oronasal fistula surgery without complications or recurrence (IRB: 2020-1671-0001). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of untreated dental caries using the pufa+PUFA index and its association with age and sex in schoolchildren aged 10 to 12 years in a public educational institution. Materials and methods: The study was descriptive, observational and cross-sectional. The data were obtained through the epidemiological survey of the period 2019, the registration was performed through the pufa+PUFA index. The relationship of variables was verified by means of Fisher's exact test. Results: A total of 136 schoolchildren aged 10 to 12 years were evaluated, 72 of whom were girls compared to 64 who were boys. The prevalence rate of untreated dental caries was 22%. At the pufa+PUFA index, the frequency was higher in the age of 11 years (9.6%) and in the male sex with (14%). In addition, no relationship was found between the study variable with age (p=0.71) and sex (p=0.179). Conclusions: No association was found between untreated dental caries and the variables age and sex in the population evaluated. [ABSTRACT FROM AUTHOR]

Pedicled buccal fat flaps have been adopted in primary Furlow double-opposing Z-plasty palatoplasty to reduce oronasal fistula formation or to attenuate maxillary growth disturbance. We combined both goals in a single intervention. This study describes a series of 33 modified Furlow small double-opposing Z-plasty palatoplasties reinforced with a middle layer of pedicled buccal fat flaps between the oral and nasal layers for full coverage of the dissected palatal surfaces, with rapid mucosalization of lateral relaxing incisions and no dehiscence or fistula formation. [ABSTRACT FROM AUTHOR]

This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library, gray literature and reference lists of selected articles. A total of 25 articles were included, 12 on closure of palatal fistula and 13 on cleft lip repair. The rate of complete resolution of palatal fistula ranged from 88.6% to 100% in studies with no control group, whereas in comparative studies patients receiving a fat graft showed better outcomes than those not receiving a graft. Evidence suggests that fat grafting can be indicated for the primary and secondary repair of cleft palate, with good results. The use of dermis-fat grafts in lip repair was associated with gains in surface area (11.5%), vertical height (18.5%–27.11%), and lip projection (20%). Fat infiltration was associated with increased lip volume (6.5%), vermilion show (31.68% ± 24.03%), and lip projection (46.71% ± 31.3%). The available literature suggests that fat grafting is a promising autogenous option for palate and fistula repair and for improvement of lip projection and scar aesthetics in patients with cleft. However, to develop a guideline, further studies are needed to confirm whether one technique is superior to the other. [ABSTRACT FROM AUTHOR]

Oronasal fistula (ONF) is a common complication encountered after palatoplasty. Repair is indicated when symptoms impact speech and swallowing. In spite of the variety of surgical approaches described to repair these defects, recurrence rates remain high. Traditionally, successful closure is said to be achieved in using a double-layered approach due to the three-dimensional aspect of the defect. The extent of the fistula into the nasal cavity has incited an increased curiosity in using local endonasal flaps. In recent years, endonasal reconstructive procedures have seen increased interest and application, from cranial base defect repairs to orbital reconstruction and beyond. The nasoseptal (NSF) and inferior turbinate flaps (ITF) possess a robust arterial supply and an exceptional reach with excellent results demonstrated in large defect repair. However, the use of these flaps in ONF repair is scarcely discussed in the literature, and their effectiveness is relatively undetermined. In this manuscript, we present a series of three patients who underwent a triple layer ONF closure, with the oral portion incorporating a turn-in mucosal flap plus a local palate rotation flap or greater palatine artery pedicled-rotation flap, and a NSF or an ITF for the nasal portion of the defect. [ABSTRACT FROM AUTHOR]

Van der Woude syndrome (VWS) is a rare syndrome of genetic etiology, commonly occasioned by mutations in the IRF6 gene and that causes disorders in craniofacial development. VWS is characterized by the presence of paramedian fistulas in the lower lip and cleft lip and / or cleft palate. Although some dental phenotypes have been reported in this syndrome, multiple and rare hypodontias were not described. Through this case report, we present a case of Van der Woude Syndrome (VWS) with rare and multiple hypodontia in which clinical data and radiographic exams were evaluated. The patient presented hypodontia of eight permanent teeth (lateral incisors, second premolars and second molars). So, when the dentist recognizes multiple and/or rare hypodontias, for an accurate diagnosis, detailed examination of the lower lip is indicated, as well as a survey of the family history and referral for genetic counseling, since the syndrome presents high penetrance. The patient is expected to be rehabilitated to have a good quality of life. Rehabilitation in these cases requires alveolar bone graft, orthodontics and prosthesis to replace missing teeth. [ABSTRACT FROM AUTHOR]

This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients (52.9%), and oroantral fistula was noted in 37 patients (55.9%). Additionally, 67 (95.7%) of the patients complained of nasal obstruction. Similarly, facial asymmetry was observed in 69 (98.6%) of the patients and double vision was observed in 24 (34.4%). Tumors of the maxillary sinus have a very insidious course of spread and uncertain clinical signs and symptoms. What makes diagnosis worse is the fact that the symptoms of these tumors are so well hidden in the sponge-like nature of the midfacial region that they are easily misinterpreted by patients. Therefore, diagnoses must be made early, dentists must be vigilant, and patients must be fully investigated at the slightest suspicion of a tumor, albeit benign. [ABSTRACT FROM AUTHOR]

BACKGROUND Wide cleft palate is a common congenital anomaly, particularly in developing countries with limited access to plastic surgeons and specialized cleft centers. It can be severe and may contribute to the development of oronasal fistula, which can occur in up to 78% of cases. Despite numerous surgical techniques for wide cleft repair, the best method remains unclear. This study aimed to identify surgical techniques for wide cleft palate repair to minimize the occurrence of oronasal fistula. METHODS Literature searching was conducted using multiple online databases including PubMed, Scopus, and Cochrane Library. The keywords used were "cleft palate", " surgery", "technique", "palatoplasty", and "wide". Inclusion and exclusion criteria were applied to select relevant studies, and the quality was assessed. RESULTS A total of 12 studies discussed surgical techniques to repair the primary wide cleft palate and their outcome on oronasal fistula formation. The surgical techniques included modified Furlow palatoplasty, two-flap palatoplasty, and modified Bardach's two-flap palatoplasty. The incidence of oronasal fistula was 9.6% (n = 28/291) in one- stage Furlow palatoplasty and 12.0% (n = 24/200) in the modified one-stage two-flap palatoplasty. CONCLUSIONS Two-flap palatoplasty and Furlow palatoplasty (and their modifications) were the safe surgical techniques for wide cleft repair with a low occurrence of oronasal fistula. [ABSTRACT FROM AUTHOR]

Background Cleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital. Methods We retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients’ medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test. Results Fistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used. Conclusions The overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

Purpose: To determine the clinical consequences of untreated dental caries among preschool children by using the pufa index (visible pulp, ulceration of the oral mucosa due to root fragments, a fistula or an abscess) and the incorporation of some risk factors.Materials and Methods: Data were collected via structured, pre-tested questionnaires from 729 parents in Turkey's capital, Ankara. Examinations were performed under field conditions by one examiner. The decayed teeth were scored according to the International Caries Detection and Assessment System (ICDAS) II criteria. The filled and missing teeth and surfaces were also recorded as dmft and dmfs, and the pufa index was used for the consequences of untreated caries. The associations were evaluated by univariate analysis and logistic regression.Results: The means age of the study population was 58.8 ± 8.6 months. 45% of the children were female and 55% were male. Mean dmft and dmfs were 4.8 ± 4.7 and 8.3 ± 10.2, respectively. 73.8% of the children had early childhood caries (ECC), while 51.0% had severe cases. Only 58 children (8.0%) had totally healthy primary teeth according to ICDAS II. Of the children with caries (n = 538), 17.5% had at least one pufa tooth. According to the logistic regression analysis, sex, having at least one sibling, extraction experience, and father's educational level were found to be the factors associated with the existence of pufa.Conclusion: Healthcare providers' attention must be drawn to both untreated carious lesions and the high ECC proportion among preschool children. [ABSTRACT FROM AUTHOR]

Oroantral fistulae (OAF) are surgical sequelae that require complete resection and often leave large defects for the surgeon to repair. Closing these lesions is often technique sensitive and requires a detailed protocol, which, if not adhered to, can lead to recurrence. This case report presents a combined approach to closing an OAF by first excising the fistula and then resecting to retrieve the buccal fat pad to form a pedicle graft over the wound site. Next, a platelet-rich fibrin membrane is sandwiched over the buccal fat pad and completely covered by a buccal advancement flap. This triple-layered technique is a novel method to close a chronic OAF. [ABSTRACT FROM AUTHOR]

Objective: Orocutaneous fistula (OCF) after reconstruction for oral cavity resection can lead to prolonged hospitalization and adjuvant treatment delay. Few studies have examined factors leading to OCF after oral cavity resection. Primary objective: evaluate overall incidence and factors associated with OCF after oral cavity reconstruction. Data Sources: Scopus 1960—database was searched for terms: "orocutaneous fistula," "oro cutaneous fistula," "oral cutaneous fistula," "orocervical fistula," "oral cavity salivary fistula." Review Methods: English language studies with >5 patients undergoing reconstruction after oral cavity cancer resection were included. About 1057 records initially screened; 214 full texts assessed; 78 full-texts included. PRISMA guidelines were followed, and MINORS criteria used to assess risk of bias. Data were pooled using random-effects model. Primary outcome was OCF incidence. Meta-analysis to determine the effect of preoperative radiation on OCF conducted on 12 eligible studies. Pre-collection hypothesis was that prior radiation therapy is associated with increased OCF incidence. Post-collection analyses: free versus pedicled flaps; mandible-sparing versus segmental mandibulectomy. Results: Seventy-eight studies were included in meta-analysis of overall OCF incidence. Pooled effect size showed overall incidence of OCF to be 7.71% (95% CI, 6.28%-9.13%) among 5400 patients. Meta-analysis of preoperative radiation therapy on OCF showed a pooled odds ratio of 1.68 (95% CI, 0.93-3.06). OCF incidence was similar between patients undergoing free versus pedicled reconstruction, or segmental mandibulectomy versus mandible-sparing resection. Conclusion: Orocutaneous fistula after oral cavity resection has significant incidence and clinical impact. Risk of OCF persists despite advances in reconstructive options; there is a trend toward higher risk after prior radiation. [ABSTRACT FROM AUTHOR]

Introduction: The occurrence of post-palatoplasty oronasal fistula (ONF) is undesirable, challenging and difficult to classify complications. The objective is to present a classification protocol for palate fistula based on the fistula's morphological, embryological criteria and symptomatology. Methods: The elaboration of the classification involved the following steps: definition of ONF; definition of anatomical references; establishment of embryological and morphological criteria; inclusion of symptomatology. Discussion: The established protocol includes strategies for identifying anatomical references of complex visualization such as foramen (FI) and the transition area between the hard and soft palate. From the point of view of embryology, the fistula can be classified as PREFI (located in the region before the FI), POSFI (located in the region after the FI) and PREPO (which affects both the region before and after the FI). The morphological criterion establishes as areas: region-1: prealveolar and/or the alveolar arch; region-2: hard palate before FI; region-3: hard palate after FI; region-4: transition between hard and soft palate; and region-5: soft palate. Symptom identification includes hypernasality, ear infections and nasal reflux, in addition to asymptomatic fistulas. Obtaining adequate intraoral photographs facilitates the protocol's applicability, and the positioning for the photographic image requires the visualization of the palatal face of the upper incisor teeth. Conclusion: The Brosco-Dutka protocol for the classification of palate fistula was developed for use by the craniofacial team during a face-to-face consultation or photographic image analysis. The proposal presents illustrations to guide the proper use of the criteria.

Fistula recurrence is high after secondary follow-up operation to close the fistula after primary palatal surgery. Therefore, preventing fistula recurrence is important. Here, we describe the technique of closing palatal fistula after palatal surgery with a buccal fat graft in 2 cases. We elevate the mucosal flap around the palatal fistula, suture the nasal mucosa, transplant the buccal fat between the nasal and oral mucosa for the palatal fistula after palatal surgery, and suture the oral mucosa. Palatal fistula did not recur after surgery. This method is simple and useful for suturable fistula and does not require a local flap. [ABSTRACT FROM AUTHOR]

This parallel blocked randomized controlled trial was done in two groups of 30 patients each to determine if placement of an antibiotic oral pack on the hard palate after hard palatal fistula repair reduces nasal air emission and fistula re-occurrence. Group A had an oral pack on the hard palate for 5 days post-operatively while group B did not. In group A, percentage of nasal air emission was tested using nasometry with and without pack. Paired t-tests were performed to compare nasal emissions for patients with and without pack. Recurrence of fistulas after 6 months between group A and B was tested using odds ratio. Effect of nasal air emission on fistula rates was tested using paired t-tests. There was a significant increase (p < 0.0001) in nasal emission after removal of the pack in group A. Fistula re-occurrence tended to be higher in group B (no pack) than group A but this was not significant (p = 0.242). There was no correlation between nasal air emission and fistula rates. In patients with recurrent fistulae, placement of an oral pack after fistula repair diminishes nasal air emission. Whether this has an impact on re-occurrence of fistulae needs to be investigated further. [Display omitted] [ABSTRACT FROM AUTHOR]

It is possible to describe the term fistula as an abnormal connection between different parts of the body. Untreated, specific infections or diseases, chronic infections, congenital deformities, traumatic injuries and postoperative recovery abnormalities may lead to the formation of fistulas. The most common types of oral fistulas can be classified as dentoalveolar, oroantral, oronasal, and orocutaneous fistulas. Dentists and doctors can frequently misdiagnose odontogenic cutaneous fistulas as cutaneous lesions or non-odontogenic infections. As a consequence of an incorrect diagnosis, it is possible for patients to undergo unneeded and ineffective treatments, such as the surgical excision of the cutaneous lesion, multiple biopsies, and repeated antibiotic administration. It has been observed that misevaluation of the lesion and repeated ineffective interventions can lead to scar formation on the skin, pit defects, hyperpigmentation, and iatrophobia. In this case report, we aimed to present the follow-up results of a patient with an odontogenic orocutaneous fistula who was misdiagnosed and treated by medical doctors from different branches. [ABSTRACT FROM AUTHOR]

Oro-antral communications/fistulae (OAC/OAF) can cause significant patient morbidity, with treatment for defects greater than 5 mm in size requiring surgical reconstruction. This technical note evaluates the effectiveness, and proposes the use of, the temporal extension of the buccal fat pad (TEBFP) for the closure of large OAC. The TEBFP can be an effective means of large OAC closure due to its ease of harvesting, with minimal damage to surrounding structures or aesthetic changes. The use of the TEBFP provides stability, versatility, and tension-free closure, with minimal postoperative complications. [ABSTRACT FROM AUTHOR]

Pierre Robin sequence (PRS) is a rare congenital abnormality that may be classified as a first branchial arch syndrome. Patients with PRS who present with cleft palate have a deformity to the soft or hard palate of the maxilla that is repaired within the first year of birth. Despite the repair, patients may experience oronasal complications. Surgical repair is usually necessary if palatal fistula presents, and prosthetic obturators are used to provide temporary relief prior to surgery. This case report outlines the steps in the successful fabrication of a custom-fitted temporary vacuum-formed prosthetic obturator using computer-aided design technology to provide a more comfortable and effective treatment option for the patient. [ABSTRACT FROM AUTHOR]

Introduction: The identification of complications of primary palatoplasty may vary among professionals from different areas of health due to the lack of standardization of the fistula classification. This study aimed to verify the consensus among professionals of plastic surgery (PC) and Speech-Language Pathology (SLP), regarding the occurrence of fistula, according to what was reported in the same craniofacial service. Methods: Analysis of the chart's records of the areas of the PC and SLP of 466 patients with cleft lip and palate was performed about the presence and location of fistula about the presence and location of fistulas, as reported in 466 medical records of patients with a history of unilateral cleft lip and palate. To compare the findings between both areas, a gold standard classification for the occurrence of fistula (GSF) was established by an experienced plastic surgeon. Results: The PC area reported that 25% of the 466 patients had a fistula compared to the 37% reported by the SLP, while the GSF indicated fistula in 35% of the cases. The Kappa statistic reveals regular agreement between GSF and PC (r = 0.32) and substantial agreement between GSF and SLP (r = 0.63). Conclusion: There was a discrepancy between the areas of Speech-Language Pathology and plastic surgery regarding the occurrence and location of the fistula after primary palatoplasty in the same craniofacial center. The data indicates the need to create and implement a standardized fistula classification system. In this way, craniofacial teams can use it effectively, taking advantage of the scientific evidence that emerges from the results of cleft lip and palate treatment.

Introduction: Palatoplasty with elevated bilateral mucoperiosteal flaps using the von Langenbeck technique associated with intravelar veloplasty is a common procedure with low rates of oronasal fistula (ONF) and velopharyngeal insufficiency. The objective is to present the author's surgical experience and the incidence of ONF among 278 patients who underwent primary palatoplasty using the von Langenbeck technique associated with intravelar veloplasty. Methods: This retrospective study analyzed the medical records of 278 patients who underwent primary palatoplasty at the Mário Covas Treatment Center for Craniofacial Malformations of the Guilherme Álvaro Hospital located in the municipality of Santos, São Paulo, Brazil, between May 2010 and May 2018. Results: A total of 278 primary palatoplasty procedures were performed; of them, 225 (80.9%) were performed in two surgical stages and 53 (19.1%) in one surgical stage. The study population included 182 men (65.5%) and 96 women (34.5%). The prevalence of left and bilateral cleft lip and palate was 26.3% and 27%, respectively, and the prevalence of bilateral cleft palate, and right cleft lip and palate was 37.4% and 7.6%, respectively. Sixty-one patients had ONF (21.94%), the incidence of which decreased progressively throughout the study period. Conclusion: Primary palatoplasty, using the von Langenbeck technique associated with intravelar veloplasty, is reproducible when performed in one or two surgical stages, and considered safe when the learning curve is reached with a complication rate similar to those in the literature.

Objective: To evaluate the efficacy of the senior author's technique of staged reconstruction in patients with recalcitrant oronasal fistulas. Design: A retrospective review of the Pediatric Plastic Surgery Cleft & Craniofacial Surgery Database of cases from September 2013 to December 2018 was conducted. Patients: A total of 31 patients who had previously undergone >1 surgical attempt to repair a fistula or patients who have failed >1 attempt at bone graft were included in this study. All patients were referrals from outside facilities. Main Outcome Measures: Primary outcomes examined included fistula recurrence, infection rates, ability to proceed with second stage bone grafting after first stage fistula takedown and reconstruction, and bone graft loss. Results: Charts of 1053 patients were reviewed and 31 (2.94%) cases met inclusion criteria for this study. Nineteen (61.3%) of these patients proceeded with the second stage of reconstruction and 100% did not experience any graft loss. Seven patients who completed the first stage are undergoing orthodontic optimization prior to bone grafting. The remaining 5 are adult patients not interested in pursuing bone grafting. All 31 patients with recurrent and recalcitrant fistulas had successful fistula reconstruction with our approach, despite multiple previous failed reconstructions. Conclusions: The 2-staged reconstructive approach described herein effectively resulted in resolution of prior recurrent recalcitrant fistulas and resulted in eventual bone grafting. By employing this technique, we report successful fistula repair and bone grafting in patients who had previously undergone multiple surgical reconstructions. [ABSTRACT FROM AUTHOR]

Introduction: Oronasal fistulae following palatoplasty may affect patients' quality of life by impacting their ability to eat, speak, and maintain oral hygiene. We aimed to quantify the impact of previous oronasal fistula repair on patients' quality of life using patient-reported outcome psychometric tools. Methods: A cross-sectional study of 8- to 9-year-old patients with cleft palate and/or lip was completed. Patients who had a cleft team clinic between September 2018 and August 2019 were recruited. Participants were divided into 2 groups (no fistula, prior fistula repair). Differences in the individual CLEFT-Q and Child Oral Health Impact Profile-Short Form 19 (COHIP-SF 19) Oral Health scores between the 2 groups were evaluated using a multivariate analysis controlling for Veau classification and syndromic diagnosis. Results: Sixty patients with a history of cleft palate were included. Forty-two (70%) patients had an associated cleft lip. Thirty-two (53.3%) patients had no history of fistula and 28 (46.7%) patients had undergone a fistula repair. CLEFT-Q Dental, Jaw, and Speech Function were all higher in patients without a history of a fistula repair; however, none of these differences were statistically significant. The COHIP-SF 19 Oral Health score demonstrated a significantly lower score in the fistula group, indicating poorer oral health (P =.05). Conclusions: One would expect that successful repair of a fistula would result in improved function and patient satisfaction, but the consistent trend toward lower CLEFT-Q scores and significantly increased COHIP-SF 19 Oral Health scores in our study group suggests that residual effects linger and that the morbidity of a fistula may not be completely treated with a secondary correction. [ABSTRACT FROM AUTHOR]

Introduction Formation of oronasal fistula is a common complication after surgical closure of cleft lip and palate (CLP). This study aimed to compare the maxillary sinus volume in 9-12-year-old CLP patients with and without an oronasal fistula who had undergone surgical closure of the cleft at 1 year of age, using cone- beam computed tomography (CBCT). Methodology This descriptive, cross-sectional, analytical study was conducted on CBCT scans of 50 patients with unilateral CLP who were between 9-12 years and had undergone surgical closure of the cleft at 1 year of age in two groups with and without an oronasal fistula (n=50). The patients were selected among those presenting to a private orthodontic office between 2001-2009 and already had CBCT scans taken for orthodontic treatment. The 3D CBCT scans were reconstructed with Mimics software, and the volume of the maxillary sinuses was measured on the images. Data were compared using t-test. Results The maxillary sinus volume was significantly smaller in patients with oronasal fistula compared with those without it (9510.7±492 mm² vs. 10278.2±512 mm², P<0.000). The maxillary sinus of the affected side was smaller than that of the unaffected side in both groups of patients with and without an oronasal fistula (P<0.05). Conclusion IImmature patients with unilateral CLP and oronasal fistula have a smaller maxillary sinus than unilateral CLP patients without an oronasal fistula, and may be at higher risk of respiratory infections. [ABSTRACT FROM AUTHOR]

Background: Salivary fistula is a relatively common complication in patients who have undergone a parotidectomy. The purpose of this study was to investigate the effects of bipolar coagulation forceps use on salivary fistulas. Methods: From March 2015 to June 2020, 177 patients who underwent a parotidectomy in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital of Central South University were recruited. The patients were divided into an experimental group and a control group based on whether bipolar coagulation forceps or sutures were used, respectively. Results: The drainage output of the experimental group was significantly lower than that of the control group (p = 0.04). The duration of dressing pressure applied in the experimental group was significantly shorter than that in the control group (p = 0.0003). Moreover, the incidence of salivary fistula in the experimental group (9.8%, 8/82) was notably lower than that in the control group (34.7%, 33/95) (p < 0.0001). In the logistic regression model for salivary fistula development, both the use of bipolar coagulation forceps (p = 0.0021) and drainage output (p = 0.0237) were associated with the presence of salivary fistulas. Conclusions: Our findings indicate that the use of bipolar coagulation forceps decreases the incidence of salivary fistula in patients who have undergone a parotidectomy. The use of bipolar coagulation forceps is a safe, effective, and convenient method to prevent salivary fistulas in patients who undergo a parotidectomy. Trial registration: Current Controlled Trials ChiCTR2100044722, Date: 26/03/2021, Retrospectively registered. [ABSTRACT FROM AUTHOR]

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate-soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI. [ABSTRACT FROM AUTHOR]

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Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤.001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P =.233; AOR = 0.86 [0.62-1.20], P =.386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P =.005; AOR = 3.14 [1.80-5.58], P <.001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula. [ABSTRACT FROM AUTHOR]

Objective: To provide an inventory of oronasal fistula repair techniques alongside expert commentary on which techniques are appropriate for each fistula type. Design: A 4-stage approach was used to develop a consensus on surgical techniques available for fistula repair: (1) in-person discussion of oronasal fistula cases among cleft surgeons, (2) development of a schema for fistula management using transcripts of the in-person case discussion, (3) evaluation of the preliminary schema via a web-based survey of additional cleft surgeons, and (4) revision of the management schema using survey responses. Participants: Six cleft surgeons participated in the in-person case discussion. Eleven additional surgeons participated in the web-based survey. Participants had diverse training experiences, having completed residency and fellowship at 20 different hospitals. Results: A schema for fistula management was developed, organized by fistula location. The schema catalogues all viable approaches for each location. For fistulae involving the soft palate, the schema stresses the importance of evaluating for velopharyngeal insufficiency (VPI) and incorporating VPI management into fistula repair. For fistulae involving the hard palate, the schema separately enumerates the techniques available for nasal lining repair and for oral lining repair in each region. The schema also catalogues the diversity of approaches to lingual- and labioalveolar fistula, including variation in timing, orthodontic preparation, and simultaneous alveolar bone grafting. Conclusions: This study employed consensus methods to create a comprehensive inventory of available fistula repair techniques and to identify preferential techniques among a diverse group of surgeons. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether revision palatoplasty was associated with increased rates of inpatient complication and wound dehiscence compared to primary palatal repair. Materials and Methods: This was a retrospective study of patients with isolated cleft palate treated with primary palatoplasty or revision surgery for fistula repair. The records were obtained from the Kids' Inpatient Database between 2000 and 2014. The primary predictor was the type of surgery, classified as either primary or revision palatoplasty. Secondary predictors included demographics and comorbidities. Primary study outcomes were the postoperative complication and dehiscence rates as noted during the hospitalization course. The secondary outcomes related to health care utilization as measured through length of stay (LOS) and hospital charges. Results: A total of 5357 total admissions (95.5% primary, 4.5% revision) were included in the final sample. Fistula repairs (odds ratio = 14.37, P <.01) had significantly greater odds of wound dehiscence. The rates of inpatient complication ranged from 3.5% to 3.7%, and there were no significant differences between primary and revision surgery (P =.82). Complications were independently associated with insurance status and congenital anomalies. Complications and wound dehiscence both significantly increased the LOS and the hospital charges. Fistula repairs had a shorter mean LOS (P =.02), however this did not translate into cost savings (P =.60). Conclusions: Although the rates of inpatient complications were not significantly different, revision palatoplasty was associated with a greater odds of wound dehiscence. Failure of a primary repair may portend an increased risk of wound failure with subsequent surgeries. [ABSTRACT FROM AUTHOR]

Objective: Palatoplasty outcome measurements vary widely among institutions. A standardized outcome metric would help provide quality benchmarks. Design: Retrospective review of primary palatoplasty patients from 2007 to 2013. Setting: Tertiary care children's hospital. Main Outcome Measures: We created a novel conceptual quality metric called "OOR" (Optimal Outcome Reporting). Optimal Outcome Reporting is designed to reflect the percentage of patients with cleft palate who experience the best outcomes: one operation, velar competence by age 5 years, and no unintended palatal fistula. Results: Optimal Outcome Reporting was 72.3% (68/94). Eight patients had "suboptimal" outcomes for having undergone more than one operation. Eighteen patients failed for velar incompetence. No additional patients fell out of the algorithm for fistula. A significantly higher proportion of nonsyndromic patients demonstrated an "optimal" result compared to syndromic patients (61/80, 76.3% vs 7/14, 50.0%; P =.04). Patients who required more than one procedure had significantly more clinic visits (32.6 vs 14.9; P <.01) and accrued higher costs compared to "optimal" patients (US$34 019.88 vs US$15 357.25; P <.01). Conclusions: Optimal Outcome Reporting represents a novel quality metric that can provide meaningful information for patients with cleft palate. Optimal Outcome Reporting utilization can help cleft centers adopt changes that matter to patients and their families. By allowing for cross-institutional comparisons in a clear and objective manner, OOR can promote competition, innovation, and value in cleft palate care. [ABSTRACT FROM AUTHOR]