Incidence of palatal fistula after palatoplasty with levator veli palatini retropositioning according to Sommerlad

The purpose of this study was to find out the incidence of palatal fistula and study the factors that influence its development after palatoplasty with repositioning of the levator veli palatini. We retrospectively reviewed 176 consecutive repairs of cleft palates during a 2-year period (2004-2006). The age of the patients at the time of repair ranged from 12 to 30 months (mode 17 months). All the palatoplasties were done either by a senior surgeon or a resident surgeon. The chi square test was used to assess whether the development of postoperative fistulas was influenced by sex, extent of cleft (as estimated by the Veau classification), age at repair, and operating surgeon. There were 12 palatal fistulas (7%), 8 of which were at the junction of the hard and soft palate, 3 in the hard palate, and 1 in the soft palate. There was no evidence to suggest that sex or age were associated with their development. Patients whose clefts had been treated by the senior surgeon had fewer fistulas (2/82, 2%) than those by the resident surgeon (10/94, 11%) (p = 0.04). The incidences of palatal fistulas in patients with clefts of the hard and soft cleft palate (7/44, 21%), and bilateral cleft lip or palate (2/21, 10%), were significantly higher than those in patients with cleft soft palate (1/37, 3%), and unilateral cleft lip or palate (2/74, 3%) (p = 0.03). Our results show that palatal fistula after repair is related mainly to the extent of the cleft and the experience of the operating surgeon. (C) 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.