Dept. of Plastic Surgery, Amsterdam UMC, location University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands.
Dept. of Plastic Surgery, Seattle Children's Hospital, Seattle, USA.
Cleft Palate Craniofac J. 2024 Mar;61(3):508-512. doi: 10.1177/10556656221149521. Epub 2023 Jan 3.
The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations.
Cross-sectional survey study.
Participants in an international webinar that focused on palatal fistula treatment were included.
Participants were presented with a survey pre- and post-webinar.
Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system.
A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system.
This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas.
本研究旨在探讨腭裂外科医生如何对腭裂瘘进行分类。我们专注于三个不同的解剖部位（硬腭、软腭、硬/软腭交界处），以分析在不同解剖部位的一致性/分歧。
横断面调查研究。
参与腭裂瘘治疗国际网络研讨会的参与者。
参与者在网络研讨会前和后接受了问卷调查。
用于分类口鼻瘘的分类系统的使用频率以及匹兹堡分类系统的组内一致性。
共有 141 名参与者在网络研讨会前完成了问卷，109 名参与者在网络研讨会后完成了调查。总共使用了四种分类系统（即匹兹堡、巴基斯坦综合瘘分类 [PCFC]、解剖学和“其他”）。在所有情况下，匹兹堡分类系统是最常用的系统。然而，匹兹堡组内一致性较低（网络研讨会前 κ=0.136，网络研讨会后 κ=0.174）。令人惊讶的是，在网络研讨会之后，从解剖学分类到匹兹堡分类的转变很大，这表明人们对匹兹堡分类系统的可用性的认识有所提高。
本研究表明，在腭裂瘘的分类方面存在很大的异质性。有趣的是，在网络研讨会之后，从解剖学分类到匹兹堡分类的转变观察到。然而，使用匹兹堡分类的组内一致性较低。以同质的方式对腭裂瘘进行分类可以增强对原发性腭裂修复的比较，并可以改善腭裂瘘的治疗。
