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The Rate of Occurrence of Oronasal Fistula Following Primary Cleft Palate Surgery: A Meta-Analysis
Michael R Bykowski, MD; Sanjay Naran, MD; Daniel Winger, MS; Joseph E Losee, MD
University of Pittsburgh Medical Center
2013-03-05
Presenter: Michael R Bykowski
Affidavit:
90% of this work represents the work of the resident; the remainder includes statistical analysis and discussion and analysis of data
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKROUND: Despite the frequency of primary cleft palate repair worldwide, the reported occurrence of oronasal fistula formation is unacceptably widely variable (between 0 to >60%). The goal of this study is to perform a meta-analysis to answer the question: What is the rate of occurrence of an oronasal fistula following primary cleft palate repair?
METHODS: The Medline database was reviewed for English-written papers published between 2000 and 2012 with the search items: "cleft palate fistula" and "cleft palate surgery". Strict inclusion and exclusion were applied to the search algorithm to specifically identify papers that report their experiences with primary cleft repairs.
RESULTS: Eleven studies, comprising 2505 children, were incorporated into our analysis. These studies were found to be statistically comparable to each other, meeting the homogeneity assumption with an acceptable I-squared value of 25.3% and a non-significant heterogeneity chi-squared p-value (0.203). The primary outcome targeted for analysis was the occurrence of an oronasal fistula, which we found to be 4.9% (95% CI 3.8-6.1%) (Figure 1). There was a significant relationship between Veau classification and the occurrence of a fistula (p<0.001) with fistulae most prevalent in patients with a Veau IV cleft. The location of fistula, based upon the Pittsburgh Fistula Classification System, were as follows: Type I, 0.0%; Type II 16%; Type III, 43%; Type IV, 41%.
CONCLUSIONS: Utilizing meta-analytical methods, we find the rate of fistula occurrence to be 4.9%. Oronasal fistula formation is impacted by Veau Classification and is most common at the junction of the primary and secondary palate.
