Difficulty Index-Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience
Difficulty Index-Based Management of Palatal Fistula After Primary Cleft Palate Repair: An Institutional Experience
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DOI：
10.1016/j.joms.2018.12.005
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发表时间：
2019-04-01
影响因子：
1.9
通讯作者：
Kumar, Niranjan
中科院分区：
文献类型：
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作者：
Saralaya, Shruthi;Desai, Anil Kumar;Kumar, Niranjan
目的：在本研究中，我们强调了不同的腭瘘的发生和评估的困难程度，在规划的治疗，从而使预测的预后preoperatively.Materials和Methods：本回顾性研究包括62例非综合征的情况下，在我们的单位进行了初步手术和腭瘘修复。收集瘘管发生率、位置、大小、裂缝类型、瘘管闭合方法等数据。结果：腭瘘的发生率为4.58%，以横型腭瘘为主，占74%。33例（53.2%）和29例（46.8%）患者的难度指数分别为1级和2级。复发率为35.4%，1级和2级组分别为6.4%和28.9%（P = 0.019）。手术方法包括舌瓣、腭再造、舌瓣旋转、舌瓣旋转联合颊脂垫。复发的发生率取决于手术治疗的类型和难度指数评分（P = 0.047）。结论：腭瘘闭合是一个技术上困难的程序，复发率高。因此，必须在术前评估闭合难度指数以预测手术结局。此外，还需要开展进一步研究，以采用瘘管病复杂性标准化分类系统，解决瘘管病管理方面的困难。(C)2018年美国口腔颌面外科医师协会
Purpose: In the present study, we have highlighted the occurrence of different palatal fistulas and evaluated the difficulty level in planning the treatment, thereby enabling the prediction of the prognosis preoperatively.Materials and Methods: The present retrospective study included 62 nonsyndromic cases with primary surgery and palatal fistula repair performed in our unit. Data were collected on the fistula incidence, site, and size, cleft type, fistula closure method. All these were categorized, analyzed, and scored according to the difficulty index reported by Richardson et al. The data were statistically analyzed using chi(2) analysis and Fisher's exact test.Results: The incidence of palatal fistula was 4.58%, with the transverse type (74%) the predominant type. The difficulty index was grade 1 and 2 for 33 (53.2%) and 29 (46.8%) patients, respectively. The recurrence rate was 35.4%, with 6.4 and 28.9% observed in the grade 1 and grade 2 groups, respectively (P = .019). The surgical techniques included tongue flap, redo palatoplasty, rotation flap, and a combination of rotation with a buccal fat pad. The incidence of recurrence was dependent on the type of surgical management and the difficulty index score (P = .047).Conclusions: Palatal fistula closure is a technically difficult procedure with a high recurrence rate. Thus, the difficulty level index for closure must be evaluated to predict the outcomes of the procedure before surgery. Also, further studies are required to introduce a standardized classification system of fistula complexity to address the difficulty in their management. (C) 2018 American Association of Oral and Maxillofacial Surgeons