Rate of fistula repair following palatoplasty in patients with cleft lip and palate: A systematic review of the literature.

Abstract

Oronasal fistulas are among the most common and burdensome complications of cleft palate repair. Despite exhaustive literature detailing the nature and incidence of palatal fistulas, the reported rates of surgical fistula repair remain contested. The aim of this study was to identify the rate of palatal fistula repair following primary palatoplasty for cleft lip and palate. The PubMed, Scopus, and Cochrane databases were queried for studies that focused on the incidence of surgical fistula repair following primary palatoplasty. Studies that included submucous clefts or were written in non-English languages were excluded. A total of 47 studies met the inclusion criteria. The average reported rate of palatal fistula repair was 6.5±5.3% (range: 0-49%). Stratified by cleft phenotype, the rate of fistula repair was 3.2±3.8% for patients with isolated cleft palate, 4.2±3.3% for patients with unilateral cleft lip and palate (UCLP), and 17.2±12.3% for patients with bilateral cleft lip and palate (BCLP). The rates of fistula repair were significantly different between the UCLP and BCLP groups (p=0.02) as well as between the BCLP and ICP groups (p=0.03). The included studies reported a range of predictors of fistula repair, including palatoplasty timing and surgeon experience, but our meta-analysis did not find an association between timing and fistula repair (p=0.84) in the aggregated data. Initial analysis demonstrated differences in fistula surgery rate when stratified by phenotype and technique. Standardization of outcomes reporting is necessary to drive more robust conclusions.