Postoperative Oronasal Fistula Formation Following The Furlow and Other Three Palatoplasty Techniques: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.25251/vdfgb389Keywords:
Cleft palate, Surgical procedures, Palatoplasty, Postoperative complications, FistulaAbstract
Introduction : The technique for repairing a cleft palate depends on the length and width of the palate and the type of cleft palate according to the Veau classification. The most common surgical techniques include the Furlow double opposing Z-plasty, the Bardach palatoplasty, the von Langenbeck palatoplasty, and the V-Y pushback. One of the most frequent complications after cleft palate repair is an oronasal fistula (ONF). This article aimed to compare the risk of postoperative ONF formation following cleft palate repair.
Method : We searched for manuscripts involving patients with ONF formation following the Furlow, Bardach, von Langenbeck, and V-Y pushback palatoplasty. Electronic literature searching of the PubMed, Scopus, and Cochrane databases was conducted for the studies published up to November 2022.
Result: The meta-analysis used 17 studies, including the analysis of 3,207 repaired cleft palates. The Furlow technique was associated with a statistically lower risk of ONF formation when compared to the von Langenbeck and V-Y pushback techniques (RR=0.06[0.43-0.840],p<0.01 and RR=0.30[0.15-0.62],p<0.01 respectively). There were no statistically significant differences regarding ONF formation between the Furlow technique and the Bardach technique (RR=1.45[0.48-0.43],p=0.51).
Conclusion: The Furlow technique is associated with a lower risk of ONF compared to the von Langenbeck and V-Y pushback techniques. There were no statistically significant differences in ONF formation between the Furlow and Bardach techniques.
References
Chung KC, editor. Grabb and Smith’s Plastic Surgery . Eight. Philadelphia : Wolters Kluwer; 2020.
Stein MJ, Zhang Z, Fell M, Mercer N, Malic C. Determining postoperative outcomes after cleft palate repair: A systematic review and meta-analysis. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2019 Jan 1;72(1):85–91.
Tache A, Mommaerts MY. On the Frequency of Oronasal Fistulation After Primary Cleft Palate Repair. Cleft Palate-Craniofacial Journal. 2019 Nov 1;56(10):1302–13.
Li Y, Wu M, Yang C, Tsauo C, Li C, Liu R, et al. Evaluation of fistula rates in three cleft palate techniques without relaxing incisions. Journal of Cranio-Maxillofacial Surgery. 2021 Jun 1;49(6):456–61.
Garg R, Shah S, Uppal S, Mittal RK. A statistical analysis of incidence, etiology, and management of palatal fistula. Natl J Maxillofac Surg. 2019 Jan 1;10(1):43–6.
San Basilio M, Lobo Bailón F, Berenguer B, Carrera EM, Bayet B, Taylor JA, et al. Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study.
Opris DA, Opris H, Dinu C, Bran S, Baciut G, Armencea G, et al. Evaluation of prognostic factors for palatal fistulas after cleft lip and palate surgery in a north-western Romanian population over a 10-year period. Int J Environ Res Public Health. 2021 Jul 2;18(14).
Smyth AG, Wu J. Cleft Palate Outcomes and Prognostic Impact of Palatal Fistula on Subsequent Velopharyngeal Function—A Retrospective Cohort Study. Cleft Palate-Craniofacial Journal. 2019 Sep 1;56(8):1008–12.
Sakran KA, Liu R, Yu T, Al-Rokhami RK, He D. A comparative study of three palatoplasty techniques in wide cleft palates. Int J Oral Maxillofac Surg. 2021 Feb 1;50(2):191–7.
Williams WN, Seagle MB, Pegoraro-Krook MI, Souza T V., Garla L, Silva ML, et al. Prospective clinical trial comparing outcome measures between furlow and von langenbeck palatoplasties for UCLP. Ann Plast Surg. 2011 Feb;66(2):154–63.
Losken HW, Van Aalst JA, Teotia SS, Dean SB, Hultman S, Uhrich KS. Achieving low cleft palate fistula rates: Surgical results and techniques. Cleft Palate-Craniofacial Journal. 2011 May;48(3):312–20.
Chan EKW, Lee KH, Tsui BSY, Wong SYS, Pang KKY, Mou JWC, et al. From von Langenbeck to Furlow palatoplasty: A 16-year review of cleft palate repair. Surg Pract. 2014;18(2):67–71.
Funayama E, Yamamoto Y, Nishizawa N, Mikoya T, Okamoto T, Imai S, et al. Important points for primary cleft palate repair for speech derived from speech outcome after three different types of palatoplasty. Int J Pediatr Otorhinolaryngol. 2014 Dec 1;78(12):2127–31.
Abdel-Aziz M, Ghandour H. Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair. Eur J Plast Surg. 2011 Feb;34(1):27–32.
Dong Y, Dong F, Zhang X, Hao F, Shi P, Ren G, et al. An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure. Int J Oral Maxillofac Surg. 2012 May;41(5):604–11.
Yuan N, Dorafshar AH, Follmar KE, Pendleton C, Ferguson K, Redett RJ. Effects of cleft width and veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. Ann Plast Surg. 2016;76(4):406–10.
Park MS, Seo HJ, Bae YC. Incidence of fistula after primary cleft palate repair: a 25-year assessment of one surgeon’s experience. Arch Plast Surg. 2022 Jan 1;49(1):43–9.
LaRossa D, Jackson OH, Kirschner RE, Low DW, Solot CB, Cohen MA, et al. The Children’s Hospital of Philadelphia modification of the Furlow double-opposing z-palatoplasty: Long-term speech and growth results. Vol. 31, Clinics in Plastic Surgery. 2004. p. 243–9.
Chan Bae Y, Kim JH, Lee J, Hwang SM, Kim SS. Comparative Study of the Extent of Palatal Lengthening by Different Methods. 2002.
Guneren E, Uysal OA. The Quantitative Evaluation of Palatal Elongation after Furlow Palatoplasty. Journal of Oral and Maxillofacial Surgery. 2004;62(4):446–50.
Park MS, Seo HJ, Bae YC. Incidence of fistula after primary cleft palate repair: a 25-year assessment of one surgeon’s experience. Arch Plast Surg. 2022 Jan 1;49(1):43–9.
Sakran KA, Liu R, Yu T, Al-Rokhami RK, He D. A comparative study of three palatoplasty techniques in wide cleft palates. Int J Oral Maxillofac Surg. 2021 Feb 1;50(2):191–7.
Dong Y, Dong F, Zhang X, Hao F, Shi P, Ren G, et al. An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure. Int J Oral Maxillofac Surg. 2012 May;41(5):604–11.
Losken HW, Van Aalst JA, Teotia SS, Dean SB, Hultman S, Uhrich KS. Achieving low cleft palate fistula rates: Surgical results and techniques. Cleft Palate-Craniofacial Journal. 2011 May;48(3):312–20.
Stotland MA, Boonipat T, Lundgren CM, Gonzalo EG. Universal Applicability of the Furlow Palatoplasty: Resident as Primary Surgeon in a Consecutive, Nonselective Series. In: Annals of Plastic Surgery. Lippincott Williams and Wilkins; 2018. p. 406–11.
Sullivan SR, Vasudavan S, Marrinan EM, Mulliken JB. Submucous cleft palate and velopharyngeal insufficiency: Comparison of speech outcomes using three operative techniques by one surgeon. Cleft Palate-Craniofacial Journal. 2011 Sep;48(5):561–70.
Yuan N, Dorafshar AH, Follmar KE, Pendleton C, Ferguson K, Redett RJ. Effects of cleft width and veau type on incidence of palatal fistula and velopharyngeal insufficiency after cleft palate repair. Ann Plast Surg. 2016;76(4):406–10.
Kahraman A, Yuce S, Kocak OF, Canbaz Y, Guner SI, Atik B, et al. Comparison of the fistula risk associated with rotation palatoplasty and conventional palatoplasty for cleft palate repair. Journal of Craniofacial Surgery. 2014;25(5):1728–33.
Gustafsson C, Heliövaara A, Leikola J. Long-Term Follow-up of Unilateral Cleft lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation. Cleft Palate-Craniofacial Journal. 2022 Dec 1;59(12):1537–45.
Yu C, Chen P, Chen Y. Comparison of speech results after Furlow palatoplasty and von Langenbeck palatoplasty in incomplete cleft of the secondary palate. Chang Gung Med J . 2001;24(10):628–32.
Ravishanker R. Furlow’s palatoplasty for cleft palate repair. Med J Armed Forces India. 2006;62(3):239–42.
Yun SP, De Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: An audit of 211 children born between 1990 and 2004. Cleft Palate-Craniofacial Journal. 2008 Mar;45(2):172–8.
Deshpande GS, Campbell A, Jagtap R, Restrepo C, Dobie H, Keenan HT, et al. Early complications after cleft palate repair: A multivariate statistical analysis of patients. Journal of Craniofacial Surgery. 2014;25(5):1614–8.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Felicia Puspita Sari, Kenny Satrio, Gede Wara Samsarga
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain the copyright of the article and grant Jurnal Plastik Rekonstruksi the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License. Articles opting for open access will be immediately available and permanently free for everyone to read, download and share from the time of publication. All open access articles are published under the terms of the Creative Commons Attribution-Non-commercial-NoDerivatives (CC BY-NC-ND) which allows readers to disseminate and reuse the article, as well as share and reuse of the scientific material. It does not permit commercial exploitation or the creation of derivative works without specific permission.
