<< Back to the abstract archive
The Rate of Oronasal Fistula After Undergoing Mandibular Distraction Osteogenesis for Robin Sequence
S. Travis Greathouse MD; Youssef Tahiri MD MSc; Roberto L. Flores MD, Sunil S. Tholpady MD PhD
Indiana University School of Medicine
2015-03-14
Presenter: S. Travis Greathouse
Affidavit:
The fellow is responsible for 90% of the original work.
Director Name: Sunil Tholpady
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Cleft palate in Robin Sequence (RS) is described as U-shaped and often wider than conventional cleft palates. The ornoasal fistula (ONF) rate is widely reported in the literature as 4.5 to 9.8%. The aim of this study was to determine the ONF rate in RS patients with disease significant enough to require mandibular distraction osteogenesis (MDO).
Methods: A retrospective review was conducted of all infants undergoing palatoplasty following MDO for RS with at least 1 year of follow-up. Demographics, co-morbidities, Veau classification, age at palatoplasty, surgical technique, complications, presence of ONF, and age at fistula repair were recorded. The presence of fistula was determined by review of the operating surgeon's orofacial cleft clinic notes.
Results: Sixty-two patients undergoing MDO met inclusion criteria. The mean age at time of repair was 19.4 months (range 8.9 to 82.3 months). The Veau classification was as follows: Veau I in 13, Veau II in 39, Veau III in 0, and Veau IV in 2. Forty-two patients (67.7%) underwent Furlow palatoplasty and 20 patients (32.3%) underwent straight line repair with intravelar veloplasty. A syndromic diagnosis was present in 18 patients (29.0%). There were clinically evident ONF demonstrated in 5 patients (8.1%). Three patients (60%) went on to require surgical closure of a fistula. The mean age of fistula repair was 3.7 ± 0.6 years.
Conclusions: The ONF rate in patients with RS undergoing MDO is 8.1%. This fistula rate lies at the upper end of reported fistula rates in systematic reviews of the literature.
