Palatal fistulae: a comprehensive classification and difficulty index.

Abstract

Palatal fistula formation is a known complication of palatoplasty. Numerous classifications have been proposed that help in identifying the location of fistula and systematically arrange data for record keeping. They do not assess the difficulty level of the fistula. Management of fistulae can be very tricky and a definitive success cannot be guaranteed even in the best of hands. Hence we devised a classification system and a difficulty index to help evaluate the difficulty level and plan the treatment accordingly to predict the prognosis prior to surgery. We reviewed 610 cases of palatal fistula operated at our center with a minimum follow-up of 6months from May 2003 to May 2010. They were classified according to our classification. Difficulty index was also assessed. The data was tabulated and analysed. Longitudinal fistulae showed a recurrence rate of 7.87% whereas transverse fistulae showed a recurrence rate of 19.66%. Total recurrence rate was 11.31%. Unilateral clefts with fistulae showed a recurrence of 6.55% whereas bilateral clefts with fistulae showed a recurrence of 14.17%. A total of 220 Grade 1 and 390 Grade 2 fistulae were managed. Out of these, 7 (3.18%) Grade 1 and 62 (15.90%) Grade 2 fistulae recurred. 90 % of failed fistulae showed decrease in the size of the fistula. Classification and evaluation of difficulty of palatal fistula is essential to plan the surgical treatment so as to give better results. Bidimensional fistulae in the anterior hard palate are associated with higher recurrence rate. Also, fistulae in bilateral clefts are more difficult to close than those in unilateral clefts. Classification of fistulae according to the difficulty index helps in pre-operative judgment of the outcome.