Prevention of Oronasal Fistula Formation in Palatoplasty With Acellular Dermal Matrix: A Systematic Review and Meta-analysis.

Objectives: The aims of the study were to update the current trends in acellular dermal matrix (ADM) utilization during palatoplasty procedures and to evaluate its effectiveness in reducing postoperative oronasal fistula formation.

Design: This is a systematic review and meta-analysis.

Patients or participants: Patients undergoing primary or secondary cleft palate repair.

Interventions: A comprehensive literature search was conducted via PubMed, Embase, Cochrane, and OVID for relevant studies published between July 2016 and June 2024 involving patients undergoing primary or secondary cleft palate repair with ADM versus without. All records were screened by two independent investigators using Covidence. Studies were excluded if they were not published in English, did not use ADM, were nonhuman, or had no reported outcome.

Main outcome measures: Postoperative oronasal fistula formation.

Results: Eight studies met the inclusion criteria. This meta-analysis alone found a nonsignificant decrease in relative risk reduction of postoperative fistula formation with the use of ADM; however, when combined with data from the most recent meta-analysis, a statistically significant decrease was found. Overall, the addition of ADM resulted in 47% lower risk of developing fistulas. Furthermore, with the combined data, the pooled proportion of fistula recurrence for primary and secondary palate repair was 6.58%, which is favorable compared to previous studies' rates with the use ADM.

Conclusions: This systematic review found a statistically significant decrease in postoperative fistula recurrence when using ADM for both primary and secondary palatoplasty. Therefore, ADM can be considered as a reliable adjunct to palatoplasty for reducing the risk of oronasal fistulas.