Department of Plastic and Reconstructive Surgery, University of Virginia Health System, Charlottesville, VA.
Department of Surgery, Division of Plastic Surgery, University of Wisconsin, Madison, WI.
J Craniofac Surg. 2021;32(2):e182-e184. doi: 10.1097/SCS.0000000000007030.
Palatal fistulae are common complications of cleft palate surgery with a frequency of 5% to 29% and are challenging to repair. Optimal timing to repair palatal fistulae, in a staged fashion before alveolar bone grafting, or at the same time, still remains controversial. The primary aim of this study is to compare outcomes of 2 groups with regard to successful alveolar bone grafting in patients with cleft lip and palate and palatal fistulae. We describe a review of 85 consecutive patients identified as undergoing bone grafting from a single institution craniofacial team during 2003 to 2018. Twenty-eight required palatal fistula repair. All patients had a diagnosis of unilateral or bilateral complete cleft lip and palate. Patients with cleft lip and palate repairs were stratified based on preoperative or simultaneous palatal fistula repair. Panoramic radiographs were reviewed by 2 physicians to evaluate success of bone grafting. Comparison between cohorts was made by statistical analysis. Of the 28 that required palatal fistula repair, 15 (53.6%) patients underwent prebone grafting palatal fistula repair and 13 (46.4%) patients underwent simultaneous bone grafting with palatal fistula repair. Mean age at time of bone grafting and palatal fistula repair were 10.60 years old and 9.39 years old, respectively. Length to follow-up was 54.82 months. The average height of the healed alveolar cleft site for patients in the prebone grafting or simultaneous groups was 10.57 mm and 11.46 mm, respectively. Patients who underwent palatal fistula repair and simultaneous bone grafting had similar outcomes as those with palatal fistula repair preoperatively.
腭瘘是腭裂手术后常见的并发症，发生率为 5%至 29%，且难以修复。关于腭裂手术后腭瘘的最佳修复时机，即在牙槽骨植骨前分期修复，还是同期修复，仍存在争议。本研究的主要目的是比较两组患者腭裂和腭瘘患者牙槽骨植骨的成功率。我们描述了对 2003 年至 2018 年期间，由单一机构颅面团队进行的 85 例连续患者进行的回顾性研究。其中 28 例需要修复腭瘘。所有患者均诊断为单侧或双侧完全性腭裂。根据术前或同期腭瘘修复情况，将腭裂患者分为两组。由两位医生对全景片进行评估，以判断植骨的成功率。通过统计学分析比较两组间的差异。在需要修复腭瘘的 28 例患者中，15 例（53.6%）患者行术前腭瘘修复，13 例（46.4%）患者同期行腭瘘修复联合牙槽骨植骨术。腭瘘修复和牙槽骨植骨术的平均年龄分别为 10.60 岁和 9.39 岁。随访时间为 54.82 个月。术前或同期行腭瘘修复的患者牙槽裂愈合区平均高度分别为 10.57mm 和 11.46mm。同期行腭瘘修复和牙槽骨植骨术的患者与术前行腭瘘修复的患者具有相似的疗效。
