Oral Health-Related Quality of Life and Self-Rated Speech in Children With Existing Fistulas in Midchildhood and Adolescence

Objective: To report the associations of oro-nasal fistulae on the patient-centered outcomes oral health-related quality of life and self-reported speech outcomes in school aged children. Design: Prospective, nonrandomized multicenter design. Setting: Six American Cleft Palate-Craniofacial Association-accredited cleft centers. Participants: Patients with cleft palate at the age of mixed dentition. Interventions: None. Main Outcome Measures: Prevalence of fistula and location of fistula (Pittsburgh Classification System). Patients were placed into one of three groups based on the following criteria: alveolar cleft present, no previous repair (Group 1); alveolar cleft present, previously repaired (Group 2); no congenital alveolar cleft (Group 3). Presence of fistula and subgroup classification were correlated to oral health-related quality of life (Child Oral Health Impact Profile [COHIP]) and perceived speech outcomes. Results: The fistula rate was 5.52% (62 of 1198 patients). There was a significant difference in fistula rate between the three groups: Group 1 (11.15%), Group 2 (4.44%), Group 3 (1.90%). Patients with fistula had significantly lower COHIP scores (F-1,F-1188 = 4.79, P = .03) and worse self-reported speech scores (F-1,F-1197 = 4.27, P = .04). Group 1 patients with fistula had the lowest COHIP scores (F-5,F-1188 = 4.78, P = .02) and the lowest speech scores (F-5,F-1188 = 3.41, P = .003). Conclusions: Presence of palatal fistulas was associated with lower oral health-related quality of life and perceived speech among youth with cleft. The poorest outcomes were reported among those with the highest fistula rates, including an unrepaired alveolar cleft.