Cleft Palate Repair by Otolaryngologist‐Head and Neck Surgeons: Risk Factors for Postoperative Fistula

2020 ◽  
Author(s):  
Grace R. Leu ◽  
Bridget E. Ebert ◽  
Brianne B. Roby ◽  
Andrew R. Scott
Keyword(s):  
Risk Factors ◽  
Cleft Palate ◽  
Head And Neck ◽  
Postoperative Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

Perioperative Risk Factors for Adverse Airway Events in Patients Undergoing Cleft Palate Repair

2013 ◽  
Vol 50 (3) ◽  
pp. 330-336 ◽  
Author(s):  
Oksana Jackson ◽  
Marten Basta ◽  
Seema Sonnad ◽  
Paul Stricker ◽  
Don Larossa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cleft Palate ◽  
Perioperative Risk ◽  
Perioperative Risk Factors ◽  
Cleft Palate Repair ◽  
Palate Repair

scholarly journals Effect of collagen matrix on postoperative palatal fistula in cleft palate repair

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jeong Hyun Ha ◽  
Yeonwoo Jeong ◽  
Youn Taek Koo ◽  
Sungmi Jeon ◽  
Jeehyeok Chung ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Characteristic Curve ◽  
Collagen Matrix ◽  
Fistula Formation ◽  
Collagen Membrane ◽  
Palatal Fistula ◽  
Postoperative Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Collagen Graft

Abstract Palatal fistula is a challenging complication following cleft palate repair. We investigated the usefulness of collagen matrix in the prevention of postoperative fistula. We performed a retrospective cohort study of patients with cleft palate who underwent primary palatoplasty (Furlow’s double opposing z-plasty) in Seoul National University Children’s Hospital. Collagen Graft and Collagen Membrane (Genoss, Suwon, Republic of Korea) were selectively used in patients who failed complete two-layer closure. The effect of collagen matrix on fistula formation was evaluated according to palatal ratio (cleft width to total palatal width) and cleft width. A total of 244 patients (male, 92 and female, 152; median age, 18 months) were analyzed. The average cleft width was 7.0 mm, and the average palatal ratio was 0.21. The overall fistula rate was 3.6% (9/244). Palatal ratio (p = 0.014) and cleft width (p = 0.004) were independent factors impacting the incidence of postoperative fistula. Receiver operating characteristic curve analysis showed that the cutoff values in terms of screening for developing postoperative fistula were a palatal ratio of 0.285 and a cleft width of 9.25 mm. Among nonsyndromic patients with values above those cutoffs, the rates of fistula development were 0/5, 1/6 (16.7%), and 4/22 (18.2%) for those who received Collagen Graft, Collagen Membrane, and no collagen, respectively. Collagen matrix may serve as an effective tool for the prevention of palatal fistula when complete two-layer closure fails, especially in wide palatal clefts. The benefit was most evident in Collagen Graft with thick and porous structure.

Adult Quality of Life Post Cleft Palate Repair

2017 ◽  
Vol 28 (4) ◽  
pp. 909-914
Author(s):  
Rachel Skladman ◽  
Lynn Marty Grames ◽  
Gary Skolnick ◽  
Dennis C. Nguyen ◽  
Sybill D. Naidoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway

2021 ◽  
pp. 105566562110174
Author(s):  
Thomas R. Cawthorn ◽  
Anna R. Todd ◽  
Nina Hardcastle ◽  
Adam O. Spencer ◽  
A. Robertson Harrop ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cleft Palate ◽  
Care Pathway ◽  
Clinical Care ◽  
Oral Intake ◽  
Opioid Consumption ◽  
Complication Rates ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinical Care Pathway

Objective: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Design: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Patients: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. Interventions: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Main Outcome Measures: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Results: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Conclusions: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

Fibrin Tissue Sealant as an Adjunct to Cleft Palate Repair

2017 ◽  
Vol 28 (5) ◽  
pp. 1164-1166 ◽  
Author(s):  
Robin Wu ◽  
Alexander Wilson ◽  
Roberto Travieso ◽  
Derek M. Steinbacher
Keyword(s):  
Cleft Palate ◽  
Cleft Palate Repair ◽  
Tissue Sealant ◽  
Palate Repair

Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

2021 ◽  
Vol 58 (5) ◽  
pp. 603-611
Author(s):  
Giap H. Vu ◽  
Christopher L. Kalmar ◽  
Carrie E. Zimmerman ◽  
Laura S. Humphries ◽  
Jordan W. Swanson ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measure ◽  
Charge Ratio ◽  
Fistula Repair ◽  
Case Volume ◽  
Secondary Surgery ◽  
Hospital Case ◽  
Oronasal Fistula ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

scholarly journals Massive lingual swelling following cleft palate repair

2013 ◽  
Vol 29 (2) ◽  
pp. 262 ◽  
Author(s):  
MC Rajesh ◽  
Saji Kuriakose ◽  
Jayanth Sukumar ◽  
EK Ramdas
Keyword(s):  
Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair
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