A Prospective Analysis of Surgeons’ Experience and Incidence of Oronasal Fistula: Focus on von Langenbeck Palatoplasty and Intravelar Veloplasty

Abstract

Context: The extrinsic causes of unintentional fistula are those pertaining to surgical technique and operative strategy. It has been reported and asserted by researchers that the surgeon performing the repair is the strongest predictor of fistula formation. Not much is known about this association in our sub-region.Aim: To determine the relationship between surgeons’ experience and oronasal fistula.Setting and Design: One year prospective non-blinded study.Materials and Method: All consecutive patients with cleft palate that presented to the study institutions within the period and met inclusion criteria were studied. Surgeons were grouped into two; experienced and less experienced. Palatoplasty was by either von Langenbeck repair or intravelar veloplasty. Patients were monitored postoperatively for fistulae.Statistical analysis used: Chi-square and Mann – Whitney U tests were used. P-values ˂0.05 were considered significant.Results: Forty-six patients were studied. Eight surgeons performed surgical procedures, three experienced and five less experienced palatal surgeons. With Intravelar veloplasty, fistula rate was 23.08% for experienced surgeons and 42.85% for less experienced surgeons. While for the von Langenbeck repair, fistulae rates were 37.50% and 70.00% for the experienced and less experienced surgeons respectively. However, these were not statistically significant. Conclusion: Though found not to be statistically significant, the surgeon’s experience predicted occurrence of fistula. Experienced surgeons had lower fistula rate with each procedure.

Keywords: Surgeons’ experience, Oronasal fistula, von Langenbeck, intravelar veloplasty.