Incidence of Residual Oronasal Fistulas: A 20-Year Experience

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.