Cleft Palate Outcomes and Prognostic Impact of Palatal Fistula on Subsequent Velopharyngeal Function—A Retrospective Cohort Study

Objective: To assess outcomes from cleft palate repair and define the level of impact of palatal fistula on subsequent velopharyngeal function.

Design: A retrospective cohort study.

Setting: A regional specialist cleft lip and palate centre within UK. Patients, Participants: Non-syndromic infants born between 2002 and 2009 undergoing cleft palate primary surgery by a single surgeon with audited outcomes at 5 years of age. Four hundred and ten infants underwent cleft palate surgery within this period and 271 infants met the inclusion criteria.

Interventions: Cleft palate repair including levator palati muscle repositioning with or without lateral palatal release.

Main Outcome Measures: Postoperative fistula development and velopharyngeal function at 5 years of age.

Results: Lateral palatal incisions were required in 57% (156/271) of all cases. The fistula rate was 10.3% (28/271). Adequate palatal function with no significant velopharyngeal insufficiency (VPI) was achieved in 79% of patients (213/271) after primary surgery only. Palatal fistula was significantly associated with subsequent VPI (risk ratio = 3.03, 95% confidence interval: [1.95, 4.69], p-value < 0.001). The rate of VPI increased from 18% to 54% when healing was complicated by fistula. BCLP repair complicated by fistula had the highest incidence of VPI (71%).

Conclusions: Cleft palate repair with levator muscle repositioning is an effective procedure with good outcomes. The prognostic impact of palatal fistula on subsequent velopharyngeal function is defined with a highly significant three-fold increase in VPI. Early repair of palatal fistula should be considered, particularly for large fistula and in BCLP cases.