Learning curve in performing palatoplasty

Abstract

Objectives: The aim of the study was to assess the influence of the experience of the surgeon on the occurrence of fistulas and breakdowns following palatoplasty. Materials and Methods: A retrospective review on the outcomes of palatoplasty done by a young surgeon in his initial 3 years of operating cleft palate was done. Cleft palate repair was performed using the Pinto's modification of Wardill–Kilner palatoplasty, Veau-Wardill-Kilner V-Y Pushback in both the techniques radical levator muscle dissection was carried out. Data were collected for age, sex, date of birth, syndrome, cleft palate type, type of repair, cleft width, length of soft palate, quality and quantity of muscle, fistula occurrence, and location of fistula. Results: Retrospective analysis was done on the outcomes of palatoplasty performed by a young surgeon in his initial 3 years at Charles pinto center for cleft lip palate and craniofacial on 220 cleft palate children which included all variants and dimensions of cleft palates. Postoperatively, the incidence of palatal fistulas occurred in 12 patients, three patients had bifid uvula, however, out of 12 patients who had fistulas only four needed fistula closure and one required a uvula re-repair; the rest healed well. Conclusion: We believe there is a learning curve in performing cleft palate repair. Our technique and principles followed in palatoplasty appear to have a low or zero fistula rate even in the initial period of learning. Furthermore, effective mentorship and guidance help in reducing errors and providing a better outcome.