Abdali Hosein, Hadilou Mansour, Feizi Awat, Omranifard Mahmood, Ardakani Mehdi Rasti, Emami Abolhasan
Department of Plastic Surgery, Isfahan University of Medical Sciences, Medical Education Research Center, Isfahan, Iran.
Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2014 Oct;19(10):956-60.
After cleft palate repair, oronasal fistula (ONF) formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods.
In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months) after repair.
The mean (range) age of studied samples was 10.7 (2-23) years. 16 patients (55.7%) were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68%) and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P < 0.001). The mean [±SD] age of failed and successfully repaired patients were 11.3 (±4.5) and 8.4 (±5.25) years, respectively (P > 0.1).
Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure.
腭裂修复术后，口鼻瘘（ONF）形成是一种较为常见且棘手的并发症。耳甲软骨移植是可用于复发性瘘管矫正的一种选择。本研究的目的是调查使用耳甲软骨移植后硬腭ONF或硬腭与软腭交界处ONF的复发率，并将该率与其他方法进行比较。
在这项观察性前瞻性研究中，纳入了2011年11月至2012年11月期间转诊至伊朗伊斯法罕的阿尔扎赫拉大学医院和德黑兰的法特梅·扎赫拉大学医院的29例患有小、中、大型ONF的患者。所有患者均为正中腭裂，其中29.6%的患者曾有唇裂且已修复。所有患者在修复后随访2年（每2个月一次）。
研究样本的平均（范围）年龄为10.7（2 - 23）岁。16例患者（55.7%）为女性，其余为男性。在2年的随访期间，我们检测到6例患者（20.68%）出现ONF复发，成功率为79.32%。应用当前方法后，经历多次复发的患者的复发率显著高于首次复发的患者（33.3%对7.1%；P < 0.001）。失败修复和成功修复患者的平均[±标准差]年龄分别为11.3（±4.5）岁和8.4（±5.25）岁（P > 0.1）。
对于≤1 cm的复发性ONF，使用耳甲软骨移植是安全有效的；对于>1 cm的ONF，耳甲软骨移植可作为主要方法，如果发生复发则选择其他复杂手术。
