Oronasal Fistula Research Articles

Early Cleft Palate Repair by a Modified Technique Without Relaxing Incisions.

This study sought to evaluate a modified palatoplasty technique (MPT) concerning the postoperative outcomes and associated influencing factors. A retrospective cohort study. One hundred forty-three consecutive patients with non-syndromic cleft palate, who received MPT before one year of age within an oral and maxillofacial surgery department of a university-affiliated tertiary hospital between 2011-2017, were reviewed. The postoperative wound healing and velopharyngeal function (VPF) were the primary outcome measures. The sex, age at surgery, cleft type, cleft width, palatal width, soft palate length, pharyngeal cavity depth, and operation duration were preselected as influencing factors. Univariate and multivariate analyses were conducted. The mean age at surgery was 9 ± 1.31 months (5-11), and the average cleft width was 9.03 ± 2.41 mm (4-15). The rate of incomplete cleft palate was 84.6% while the complete cleft palate was 15.4%. Complete wound healing was reported in 96.5% while the others (3.5%) had persistent oronasal fistula. About 90.2% of cases have shown normal velopharyngeal function whereas the others (9.8%) had sustained velopharyngeal insufficiency. The wound healing appeared to be significantly impacted by cleft width and pharyngeal cavity depth (P = .015 and 0.049, respectively). However, none of the factors had a significant association with VPF. The present modified palatoplasty technique has obtained a low fistula rate and appropriate speech outcome. Therefore, this MPT could be promoted for early repairing cleft palate of different severities.

Teaching Unilateral Cleft Lip Repair: Lessons Learned from Simulation

BACKGROUND: Traditionally, learning how to perform cleft lip repair required becoming familiar with markings, followed by learning the operation through assisting with surgery. During a recent study examining the use of cleft lip simulation for evaluating surgical aptitude and impact on long-term learning, we noticed residents and fellows often skip or inadequately perform crucial steps in the procedure. That surprising observation inspired the current study, which aims to identify specific areas for improvement in teaching of cleft lip repair. METHODS: Secondary analysis of existing data looked granularly at performance during an uncoached cleft lip repair on a high fidelity simulator. Simulation videos were anonymously rated by two surgeons using an 18 item Unilateral Cleft Lip Repair competency assessment tool (1-3 scale for each item), subdivided into ‘Marking’, ‘Performing’, and ‘Result’ sections. Mean scores for each skill were rank ordered to identify elements of the procedure that participants performed best (indicating adequate teaching) and worst (suggesting improvement needed). Association between objective outcome (represented by a digitally measured symmetry index) and performance on particular steps of the procedure was examined using Pearson R to determine which items were most important for a symmetrical result, and which were likely to improve with progression through training (ie. correlated with PGY). RESULTS: Simulation participants (n=26) of all training levels scored highest on skills in the ‘Marking’ subscale (2.38-2.63 mean score). Participants scored relatively poorly on some items of the ‘Performance’ subscale (2.00-2.46 mean score), and most items of the ‘Result’ subscale (1.67-2.25 mean score). Procedural steps that scored lowest were: closing the nasal floor (2.00), repairing oral mucosa (2.15), avoiding over/under-dissection (2.19), avoid unneccessarily retaining or resecting tissue (2.21), and fully mobilizing the lesser segment (2.23). Interestingly, while the latter three items all significantly correlated with symmetry of the repair (R=-0.54, -0.59, and -0.66 respectively) and with PGY (R=0.48, 0.47, and 0.45 respectively), the former two items did not correlate with either symmetry or PGY. CONCLUSION: All elements of marking a unilateral cleft lip repair scored well, suggesting that simulators and likely educators appropriately teach cleft marking. Skills involving tissue handling and understanding tissue mobility improve with higher training levels, likely because these are universal plastic surgical concepts that progress with experience. Scores for closing the nasal floor and repairing the oral mucosa scored lowest and did not improve with higher training levels; this suggests we do not optimally teach these maneuvers, perhaps because they are harder to see and understand while watching an operation. Although they do not correlate with external appearance (symmetry), these elements are important for functional outcome, because leaving the nasal floor open creates a persistent oronasal fistula that allows food escape into the nose. Inadequately repairing oral mucosa can allow the labial sulcus to herniate downward with smiling. Proposed interventions include dedicated teaching for these nuanced steps, and incorporating more video and simulation to demonstrate maneuvers that are difficult to visualize in vivo.

Random mucosal rotating flaps for rostral to mid maxillary defect reconstruction: 26 dogs (2000-2019).

To evaluate the feasibility and the complications following single or double random mucosal rotating (transposition or interpolation) flaps for the closure of rostral to mid maxillary defects in dogs. Medical records of dogs treated with single or double random mucosal rotating flaps after maxillectomy for oral lesions or traumatic loss of tissue, were evaluated. Clinical findings, surgery performed, outcome and postoperative complications (major and minor) were extracted. Twenty-six client-owned dogs were retrospectively included. Dogs underwent maxillectomy for canine acanthomatous ameloblastomas (9), oral squamous cell carcinomas (4), peripheral odontogenic fibromas (4), oral melanomas (3), oral fibrosarcomas (2), dentigerous cysts (2) and oral osteosarcoma (1) and trauma resulting in an oronasal fistula (1). Twenty-three dogs underwent a single transposition or interpolation flap and three dogs were treated with a double transposition flap. Postoperative complications, including dehiscence or flap necrosis, occurred in six dogs. Random mucosal rotating (transposition or interpolation) flaps are versatile when used to close rostral maxillary defects in dogs. Postoperative complications appear to be more likely when these flaps are used to close mid maxillary defects.

25-year Follow-up of Primary Tibial Periosteal Graft for Hard Palate Repair in Cleft Lip and Palate: Outcomes, Concerns and Controversies.

This study evaluates long-term outcomes in adults with Unilateral and Bilateral Cleft Lip and Palate (UCLP/BCLP) treated during the period 1992 to 1995 with tibial periosteal graft in primary repair. Retrospective study. Department of Plastic and Maxillofacial Surgery, Children's Hospital Bambino Gesù (Italy). The study included 52 patients with non-syndromic BCLP/UCLP who met the inclusion criteria. All patients underwent a standardized surgical protocol using a tibial periosteal graft as primary repair of the hard palate. Long-term outcomes on maxillary growth, residual oronasal fistula, and leg length discrepancy. About <2% of patients showed oral-nasal communication. Mean value of maxillary depth was 86° ± 4.5°. The lower value for maxillary retrusion was 76.8° in relation to the Frankfurt plane. At the x-ray control, 12.2% of patients showed leg discrepancy with a difference of always <2 cm. The rate of maxillary retrusion obtained was the same if compared to other techniques. Tibial periosteal graft reduces the risk of fistula and the need for reintervention after secondary bone graft. The study did not observe negative impacts on leg growth after 25 years.

The Sommerlad-Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors.

To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad-Furlow modified palatoplasty technique. Retrospective cohort. A total of 429 patients with cleft palate, who received Sommerlad-Furlow modified technique between 2011-2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected. Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42-4) years, and the average cleft width was 10.15 ± 2.95 (4-27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p= 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p˂0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve=0.611, p= 0.002) was the cutoff value for predicting the incidence of VPI. The Sommerlad-Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes. 4 Laryngoscope, 133:822-829, 2023.

Quality of life in preadolescent orthodontic patients before and after secondary alveolar bone grafting

We evaluated the effects of secondary bone grafting (SBG) on oral health-related and generic health-related quality of life (OHRQOL and HRQOL, respectively) in preadolescent orthodontic patients with alveolar bone defects. We divided 101 orthodontic patients aged 8-10 years into 3 groups: 39 general orthodontic patients, 18 patients with orofacial clefts who did not require SBG, and 44 patients with alveolar defects who required SBG using particulate cancellous bone and marrow obtained from the iliac crest. The participants completed the self-report Child Perceptions Questionnaire (CPQ) and Paediatric Quality of Life Inventory (version 4.0) for OHRQOL and HRQOL, respectively, and their scores were assessed. The quality of life (QOL) of patients who required SBG was examined before, 1 month, and 6 months after SBG. The relationships between OHRQOL or HRQOL and potential patient factors were also evaluated. Physical HRQOL subscale scores worsened 1 month after SBG, whereas the total OHRQOL and HRQOL scores before and after SBG showed no significant changes. OHRQOL and HRQOL showed no significant differences among the 3 groups before SBG. The presence of oronasal fistula was associated with poorer OHRQOL in patients with cleft lip and/or palate. SBG and orthodontic treatment had a relatively small impact on the QOL of the preadolescent children in this study. Understanding the influence of SBG and patient factors on QOL would enable better treatment and care for these patients.

Rapid Additive Manufacturing of a Superlight Obturator for Large Oronasal Fistula in Pediatric Patient.

This study developed a novel digital workflow to fabricate a 3D printed hollow obturator for the prosthetic reconstruction of palatal fistula. It will provide cleft surgeons and therapists a choice for treating children with large palatal fistula before the appropriate age for surgical reconstruction. Laryngoscope, 133:1507-1512, 2023.

Reconstruction of Oronasal Fistula with Tongue Flap: A Cleft Palate Report.

Oronasal fistula can persist after conventional secondary alveolar bone graft surgery, which may lead to functional issues, such as regurgitation of fluids from the oral to the nasal cavity. This manuscript describes a clinical case of a patient with a bilateral cleft lip and palate that underwent tongue graft surgery for closure of an oronasal fistula after three failed local mucosa flap surgeries. The multidisciplinary treatment was comprised of orthodontic treatment, mucosa and alveolar grafts for palate closure and aesthetic rehabilitation of the anterior maxillary teeth. Smile aesthetics were noticeably improved, enhancing the patient’s self-perception and confidence.

Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?

An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. Retrospective single-surgeon study. Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P = .002). Age, presence of cleft lip, and cleft width were not associated (all P > .05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P = .546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P = .143), rate of lateral incision (18.5% vs 4.2%; P = .195), and postoperative complication rate (0% vs 0%). This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication.

537 Oro-Nasal Fistula: A Very Rare Complication Following Routine Palatal Biopsy

Abstract Biopsies of the palate are generally well-tolerated with known complications of pain, bleeding, or infection, that can usually be well-controlled. We report a case of a 63-year-old male who developed a rare complication following a biopsy of an ulcer on the junction between hard and soft palate. Despite an uneventful routine biopsy, the patient presented with an oro-nasal fistula and complaints of nasal discharge. The cause of the fistula was unclear, and the histopathology results excluded malignancy. The possible hypotheses considered for this very rare and unusual complication were infection, vascularity, and underlying systemic co-morbidities. We believe in this case that the cause of wound breakdown was secondary to loss of vascularity of the mucosa from his CPAP device. The patient has since been referred to a tertiary unit for consideration of surgical repair. To the author's knowledge, there are no similar published reports of such complications following routine palatal biopsy.

Reconstruction of oral cavity defects using myogenous-only scapular tip free-flaps.

BackgroundOral cavity reconstruction is very challenging anatomical subsite to reconstruct. Large defects often require free tissue reconstruction to provide the best chance of form and function. Additionally, free tissue reconstruction aids to prevent fistula formation. We aimed to determine outcomes of oral cavity defect reconstruction using scapular tip free flaps with a myogenous intraoral component.MethodsAll patients with a mandibular or maxillary bony defect that included a disruption of the intraoral mucosa component between 07/1/14 and 07/31/17. Patients were reconstructed with a scapular tip free flap, which included a muscular component that was used to recreate the oral mucosa. The primary study outcomes were flap success rates, development of orocutaneous or oronasal fistula, rate of resuming oral diet as well as the occurrence of medical and surgical complications in the first month following surgery. The tested hypothesis was formulated before data collection began.ResultsTwenty‐five patients were identified by the study criteria. There was one (4%) flap that failed, while orocutaneous fistula occurred in two patients (8%). Prior history of osteoradionecrosis was a statistically significant predictor of overall complication (p < .05).ConclusionsIntraoral myogenous reconstruction allows for re‐mucosalization of the oral cavity defect and is associated with high viability and low‐complication rates. In patients with amenable oral mucosal defects, a myogenous scapular tip free flap is a suitable reconstructive option.

Surgical Treatment and Outcome of Acquired Midline Palate Defects in Cats.

Acquired midline palate defects (PDE) affect the hard palate and/or soft palate, and result from trauma, commonly falling from a height or being hit by a motor vehicle. Additional life-threating injuries and costs associated with the treatment may delay the surgical treatment. This retrospective study describes signalment, cause, and extent of the PDE, and treatment in 25 cats. In addition, the outcome of the surgical repair is described in 19 (76%) cats. All defects were repaired within 5 days of the injury. Twenty (80%) cats were 4 years of age or younger. The most common rostral extent of the PDE was to the level of the third premolar tooth (n = 8; 32%), incisor teeth (n = 7; 28%), and fourth premolar tooth (n = 5; 20%). The soft palate laceration was present in all cases. Surgical therapy was successful in all cases with follow-up. The most common techniques used for the closure of the hard palate defect were bilateral pedicle flaps with lateral releasing incisions (n = 8; 32%), direct apposition of the oral mucosa (n = 7; 28%), bilateral pedicle flaps with lateral releasing incisions and interquadrant splinting (n = 5; 20%), and unilateral pedicle flap with one lateral releasing incision (n = 4; 16%). A tension-free closure by direct apposition of the edges was possible for the soft palate laceration. No oronasal fistulae were identified at follow-up. The only complication was malocclusion. The interquadrant splinting was most often used for PDE extending to the rostral portion of the hard palate (p < 0.05). The cats that suffered postoperative malocclusion were significantly more likely to have sustained temporomandibular joint injury, underwent CT scan, or had a feeding tube placed before discharge. The results of this retrospective study indicate that the early treatment (within 5 days) of the acquired longitudinal defects in the midline of the hard and soft palates is highly successful.

Feline upper respiratory tract disease - Computed tomography and laboratory diagnostic.

Background and Aim:Upper respiratory tract disease (URTD) is prevalent in cats, and diagnosis can be challenging. This study aimed to determine the most common causes of cat URTD in Latvia and describe computed tomography (CT) and laboratory diagnostic findings.Materials and Methods:The present retrospective study included a total of 94 cats who were diagnosed with URTD. All cats underwent CT, and 50 of them had additional diagnostic tests, such as histology and respiratory infection polymerase chain reaction (PCR) testing.Results:The most common CT finding was rhinosinusitis (55.32%) followed by nasal neoplasia (26.6%) and nasopharyngeal polyp (14.89%), but in three cats, a cause of respiratory symptoms was larynx neoplasia, nasal dermoid cyst, and an oronasal fistula. PCR test showed that the most cause of rhinosinusitis was Mycoplasma felis. Nasopharyngeal polyp as the primary diagnosis was identified in 14 cats from 3 months to 6 years, with an average age of 1.85 ± 1.915 years, and 54% of cats were female. Nasal neoplasia as a primary CT diagnosis was determined in 25 cats at the age of 5–18 years, with an average age of 10.56 ± 3.416 years. Histology diagnosis included four types of neoplasia – squamous cell carcinoma, sarcoma, adenocarcinoma, and aplastic carcinoma.Conclusion:This study describes the most common CT and laboratory findings in cats with URTD. Included information will be helpful for general veterinary practitioners and researchers and will update their knowledge on feline URTD.

Palatal mucoperiosteal flap for oro-nasal fistula following maxillectomy for maxillary sinus cancer

ObjectivesThis study aimed to describe the technique and clinical outcomes of using a palatal mucoperiosteal flap for oro-nasal fistula closure following resection of maxillary sinus cancer. MethodsThe study was conducted with the permission of the internal review board of the Japanese Red Cross Wakayama Medical Center. Five consecutive cases from 2016 to 2020 of surgically treated maxillary sinus cancer in which the oro-nasal fistulas were closed using a palatal mucoperiosteal flap were retrospectively reviewed. ResultsFollowing tumor resection, the oro-nasal fistula was closed using a palatal mucoperiosteal flap. Complete separation of the oral and nasal cavities was achieved in four patients. Oral intake was resumed within two weeks in four patients. All the patients were able to eat foods similar to those in the preoperative period. Their postoperative speech function was excellent, with no difficulty in communicating with others. ConclusionIn the selected cases of maxillary sinus cancer, preservation of the palatal mucosa and closure of an oro-nasal fistula using a palatal mucoperiosteal flap was possible with reasonable outcomes for swallowing and speech functions. The use of this local flap is recommended as a minimally invasive procedure that can be performed especially in patients with limited physiological reserves which preclude free flap reconstruction.

On the issue of hygienic maintenance of post-resection maxillary obturator prostheses (literature review)

Based on literature data, this article reviews a range of problems associated with hygienic care after obturation prostheses and the oral cavity after combined treatment of malignant neoplasms. At the present time, replacing prosthetic care after maxillary resection due to malignant neoplasms using obturator prostheses is the main method for rehabilitation of oncological patients. Such methods as dental prosthetic care based on dental implants and removable dentures for elimination of partial and complete edentulism is impossible in such conditions. A defect in the maxilla, an oronasal fistula, post-operative and post-radiation jaw contracture as well as hyposalivation, impair the hygiene of the oral cavity. Acrylic plastics used for production of obturator prostheses have such substantial flaws leading to development of inflammation and progression of atrophy in the supporting tissues of the basal seat. This reduces short-term and long-term efficacy of orthopaedic dental rehabilitation procedures after replacing dental prosthetics. A conclusion has been drawn on the necessity of development and practical introduction of a special complex of dental hygienic procedures — professional and individual — adapted for oncological patients that would be implemented within the framework of dynamic dispensary observation in the setting of a dental polyclinic.

Pathways for the rehabilitation of resection defects in the maxilla.

Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.

Unicortical Bone Necrosis of the Fibula Free Flap Associated to the Fixation with a Nonlocking 2.0-mm Reconstruction Plate and Screws.

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

Palatoplasty Using Alveolar Ridge Incisions: A Novel Approach for Addressing Cleft Palate Deformities.

Background:Traditionally, plastic surgeons have performed palatoplasties using mucoperiosteal flaps with lateral incisions that are medial to the alveolar ridge. However, narrow flaps can cause limitations in some cases. To construct larger and wider flaps and minimize exposed bone after closure, we propose a novel technique that entails creating the lateral incisions at the top of the alveolar ridge, instead of the base of the alveolar ridge, to capture more tissue when repairing the hard palate.Methods:A retrospective chart review was conducted for patients undergoing cleft palate repair with the aforementioned technique. Information collected included basic demographic and diagnostic factors related to cleft palate deformity and history of previous facial surgeries. Operative report details and postoperative complications were analyzed.Results:Nineteen patients with hard palate clefts were included in the analysis, with the majority being women (68%). There was a balanced representation of patients with Veau classifications of II (47%) and III (42%). The majority of patients had an isolated cleft palate (74%) and incomplete deformity (63%), with no other craniofacial deformities. One (5%) had postoperative self-limited oronasal fistula managed conservatively.Conclusions:We present a novel approach for repairing cleft palate deformities by extending the lateral incision to the top of the alveolar ridge to create larger mucosal flaps. Further longitudinal studies are needed to evaluate how this unique approach compares to traditional methods—with respect to impact on maxillary growth processes, requirement for subsequent surgeries beyond two years of follow-up, and ultimately normalized speech over time.

Secondary Alveolar Bone Grafting in Patients with Unilateral and Bilateral Complete Cleft Lip and Palate: A Single-Institution Outcomes Evaluation Using Three-Dimensional Cone Beam Computed Tomography.

Secondary alveolar bone grafting of autologous bone from the iliac crest is a widely accepted modality for repair of residual alveolar cleft in patients with mixed dentition with previously repaired complete cleft lip and palate. There remains debate regarding surgical timing and preoperative, perioperative, and postoperative management of these cases. This retrospective study reviewed patient demographic information in addition to preoperative, perioperative, and postoperative course to evaluate how patient and practice factors impact graft outcomes as assessed by three-dimensional cone beam computed tomographic evaluation at the 6-month postoperative visit. On univariate analysis, age at operation older than 9 years, history of oronasal fistula, history of cleft lip or palate revision, and history of international adoption were all found to significantly increase likelihood of graft failure (p < 0.05). On multivariate analysis, age older than 9 years was found to be the single most significant predictor of graft failure (p < 0.05). There was no significant difference in graft outcomes between patients with unilateral or bilateral cleft lip and palate, and no single variable was found to significantly correlate to increased complication rates. The graft success rate overall of the authors' practice was 86.2 percent, with a complication rate of 7.7 percent. Secondary alveolar bone grafting is an integral part of the cleft lip and palate surgical treatment series; this study identified several outcome predictors for both graft failure and adverse events, the most significant of which was age at operation. Although the mixed dentition phase often extends to 12 years of age, it is recommended that bone grafting be performed before 9 years of age to optimize outcomes. Risk, III.

The use of acellular dermal matrix in palatoplasty to decrease the rate of postoperative oronasal fistula.

Different cleft palate repair techniques have been described to achieve optimum results and minimise complications. Postoperative fistulae are one of the most challenging complications after palate repair. In this clinical study, we reviewed the records of patients who underwent palatoplasty using acellular dermal matrix (ADM) as an addition to facilitate difficult cleft palate and palatal fistula closure. It was a retrospective, comparative, single-centre study, in which records of patients who underwent cleft palate surgeries between 2015 and 2018 were reviewed. Patients who underwent cleft palate or palatal fistula repair with and without ADM were included. Fischer's exact test was used to compare the two groups (primary cleft palate repair with and without ADM) in relation to the rate of fistula occurrence postoperatively. Charts of a total of 31 patients were reviewed. ADM was used in 13 patients; 8(61.5%) were primary repairs and 5(38.5%) were fistula repairs. Eighteen patients were repaired without ADM, of whom 16(88.9%) were primary cleft palate repairs and 2(11.1%) were fistula repairs. The statistical analysis showed no significant difference in fistula formation rate or recurrence in both the groups. ADM is a simple, safe, and helpful tool for augmenting cleft palate repair, mainly in relatively wide and high-tension cleft palate repairs. In our study, a trend showing decreased complications with ADM was observed. Therefore, we recommend a multi-centre study with a larger sample to assess the significance of ADM in cleft palate and palatal fistulae repair.