Width of cleft palate and postoperative palatal fistula – do they correlate?

This study was conducted to evaluate any correlation between the measured width of cleft palates and postoperative fistula formation. Prospective study design was used where 43 consecutive cases of patients with cleft lip and palate or isolated palate who underwent cleft palate repair in an institution were observed. A preoperative or peroperative dental impression of the upper jaw was taken for the measurement of various cleft parameters. Palatoplasty was done using the Von-Langenbeck procedure or modified Veau-Wardil-Kilner-type repair. Among these, only 31 patients could be followed up for at least 4 weeks after the surgery and were included in the study. The patients developing fistulas were evaluated with respect to size, site and initial cleft dimensions. Statistical evaluation of multiple variables was performed.

It was found that the width of the cleft palate has a bearing on the occurrence of postoperative palatal fistula formation, with a width of 15mm or more having a statistically significant risk of fistula formation. The strongest association was found for the ratio of cleft width to the sum of the palatal shelves width. As this ratio increases to 0.48 or more, the risk of fistula becomes statistically significant. The ratio of cleft width to the posterior arch width is also a strong predictor of fistula formation with the risk becoming higher if the ratio is more than 0.41. Thus, the concept of wide-cleft is not vague or irrelevant but has a bearing on postoperative fistula formation, as shown in this study.