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Furlow Palatoplasty & Perioperative Steroid Use: A Single Surgeon Retrospective Review of 161 Patients
Jessica A Lee, Chelsey Johnson, Matthew Ford, Lorelei Grunwaldt
University of Pittsburgh
2016-02-14
Presenter: Jessica A. Lee
Affidavit:
Presented at the Northeastern Society of Plastic Surgeons
Director Name: J Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
PURPOSE: Fistula rates in cleft palate repair vary by technique, surgeon, and institution. A recent meta-analysis reports a fistula rate of 4.9%. Although steroids are commonly used in airway surgery, many surgeons are reluctant to use steroids in cleft palate surgery where near perfect healing is paramount to successful outcomes.
METHODS: A retrospective review was performed of all cleft palate surgeries by a single surgeon from 2010-2014. Patients with <90 days of postoperative follow-up were excluded. Data reviewed included demographics, type of cleft, perioperative steroid use, length of stay, and fistula formation.
RESULTS: 161 charts were reviewed; 26 were excluded because of inadequate follow-up. Of the 135 remaining patients, 65 had submucous cleft palates, 57 had Veau I-IV clefts, and 13 had previous cleft palate surgery and were undergoing redo or conversion palatoplasty. All patients underwent furlow palatoplasty by the senior author. Median age at surgery was 3.4 years. 84% of patients received perioperative steroids. 4 patients developed a fistula; of these, 2 had received steroids, and all 4 were in the Veau I-IV group. Overall fistula rate was less than 3%. There was no significant relationship between development of fistula and steroid use (p = 0.263). Average length of stay in the hospital was 2.0 days in patients who received steroids and 2.5 days in patients who did not (p <0.05).
CONCLUSIONS: Perioperative use of steroids in cleft palate surgery does not lead increased fistula rate, and in fact may decrease postoperative pain and swelling, leading to shorter hospitalizations.
