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Insights From 800 Cleft Palate Repairs: Long-term Outcomes And Risk Factors From A Single-institution Study
Eloise Stanton, MD,
Melanie Bakovic, BS, Raina Patel, BS, Asli Pekcan, BS, Valeria Mejia, BS, Pasha Shakoori, MD, DDS, William Magee, III, MD, DDS, Mark M. Urata, MD, DDS, Jeffrey Hammoudeh, MD, DDS.
Children's Hospital Los Angeles, Los Angeles, CA, USA.
PURPOSE:Patients undergoing cleft palate (CP) repair may require additional procedures for palatal fistulas, velopharyngeal insufficiency (VPI), and midface hypoplasia. This study examines trends in these outcomes and evaluates risk factors for secondary procedures at a single institution.
METHODS:We retrospectively reviewed patients who underwent CP repair between 1994 and 2019 at a tertiary institution, excluding those with less than five years of follow-up. Outcomes included rates of post-CP-repair palatal fistulas, VPI surgeries, and orthognathic surgeries or recommendations for orthognathic surgery.
RESULTS: Of the 812 patients who met inclusion criteria, 630 were non-syndromic. The median age at CP repair was 12.1 months, with a median follow-up of 11.8 years. Over time, rates of palatal fistulas (β = -0.808, p<0.001), VPI surgeries (β = -0.395, p<0.001), and orthognathic surgeries (β = -4.612, p<0.001) significantly decreased despite a rising trend in CP repairs (β = 1.476, p<0.001). In multivariate analysis, bilateral CP and older age at CP repair increased odds of postoperative palatal fistulas, while straight-line repair (SLR) palatoplasty was protective. Bilateral CP and palatal fistulas increased the risk of VPI surgery rate, while surgeon experience and SLR were protective. Bilateral CP, palatal fistulas, and palatal expansion increased the risk of orthognathic surgery, while SLR was protective.
CONCLUSION: In high-volume institutions, factors like cleft type, repair timing, repair technique, and surgeon experience significantly influence outcomes, suggesting that targeted interventions may optimize long-term results.
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