Closure of Persistent Oronasal Fistulae after Cleft Palate Repair with Acellular Dermal Matrix

Objectives: Fistula presence represents a failure of the surgical repair of the cleft palate. Fistula repair is challenging with a high rate of fistula recurrence that increases with each added repair attempt. In the present retrospective study, we review the efficacy of using acellular dermal matrix (ADM) for cleft redo palate fistula closure.

Methods: Twenty consecutive patients were included in the study from 2013 to 2016. Each patient was assigned a Veau designation and a Pittsburgh fistula classification. All patients with palate fistula, underwent fistula repair utilizing ADM as an interposition layer.

Results: There were 11 females and 9 males. Mean patient age was 13.9 years, ranging from 2 to 43 years. The mean length of follow-up was 9.7 months. Complete fistula closure was obtained in 16 patients; one patient had asymptomatic recurrent fistula; two patients had partial closure with reduction of fistula size and minimal nasal regurgitation; one patient developed a recurrent fistula without changes in symptoms (success rate of 85%).

Conclusion: Utilizing ADM for cleft palate fistula repair as an interposition layer is a safe and simple procedure, with satisfactory outcomes that reduces fistula recurrence compared to closures without ADM. A larger, prospective, randomized trial is required for determining efficacy in secondary and tertiary fistula repairs.