The relationship between cleft width and oronasal fistula

Context: Width of cleft palate influences difficulty of surgical repair and indirectly the outcome. Palatoplasty complicated with oronasal fistula causes persistence of speech, feeding, and social problems. Subsequent closure of palatal fistula has high recurrence rate. Aim: To determine the relationship between palatal cleft width and oronasal fistula. Setting and Design: One-year prospective nonblinded study. Materials and Methods: All consecutive patients with cleft palate that presented to the study institutions within the period, and met inclusion criteria were studied. The width of the palatal cleft defect was measured intraoperatively. Statistical Analysis Used: Chi-square and Mann-Whitney U-tests were used. P < 0.05 were considered statistically significant. Results: Forty-six patients were studied out of 53 patients seen during the study period. These were 22 males and 24 females giving male to female ratio of 0.92:1. Patients′ ages ranged from 10 months to 28 years; 52.17% of the study population were 2 years and below while 47.83% were aged over 2 years. Cleft width ranged from 4 to 25 mm. Nineteen patients developed fistula. Thus, the overall rate is 41.30%. Likelihood of fistula occurring increased as the width of cleft increased. Fistula rate was higher for patients with cleft width above 15 mm. Fistula rate for intravelar veloplasty was 30% and 50% for von Langenbeck repair; this was not statistically significant. Conclusion: Cleft width is a strong factor in the development of oronasal fistula. The fistula rate suggests a high burden of the problem. Efforts should be made to improve management outcome.