Congenital palatal fistula associated with submucous cleft palate: Surgical outcomes and insights from a case series of 27 patients.
Publication/Presentation Date
12-5-2025
Abstract
BACKGROUND: Congenital palatal fistula (CPF), most often associated with submucous cleft palate (SMCP), is a rare clinical entity. Surgical management is challenging owing to anatomical variation and risk of persistent velopharyngeal insufficiency (VPI). We reported outcomes from a case series of 27 patients with CPF associated with SMCP managed using a standardized institutional algorithm.
METHODS: A retrospective review was conducted at CLAPP Hospital, Lahore, from 2015 to 2020. Patients with CPF associated with SMCP were included; acquired fistulae and syndromic cases were excluded. Fistulae were classified using the Pakistan Comprehensive Fistula Classification Scheme. SMCP was further stratified according to the CLAPP Classification and Treatment Algorithm, guiding surgical approach (midline incision, modified Langenbeck, or standard Langenbeck with/without adjunctive procedures). Outcomes included fistula recurrence and speech results.
RESULTS: The cohort comprised 27 patients (mean age 9.9 years; range 1-23 years), and 52% were female. Two patients (7.4%) developed postoperative fistula recurrence. Preoperatively, 94% of patients had severe hypernasality (G3). Postoperatively, mean composite speech scores improved by 52.3% (14.9→7.1). Fourteen patients [14/17 (82.4%)] achieved G0/G1 (normal resonance). Younger patients (< 12 years) showed greater improvement (90% to G0/G1) compared to older patients (71.4%). No middle-ear sequelae were observed.
CONCLUSIONS: A tailored algorithmic approach for CPF associated with SMCP yielded low recurrence (7.4%) and substantial speech improvement. Younger patients demonstrated greater postoperative speech benefit, underscoring the importance of early diagnosis and repair.
Volume
113
First Page
419
Last Page
427
ISSN
1878-0539
Published In/Presented At
Daiem, M., Fayyaz, G. Q., Bashir, M. M., Irfan, S., Turk, M., Alonso, N., Jackson, O., Flores, R., Miles, M. G., Scopelliti, D., Nolte, J., & Breugem, C. (2025). Congenital palatal fistula associated with submucous cleft palate: Surgical outcomes and insights from a case series of 27 patients. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 113, 419–427. Advance online publication. https://doi.org/10.1016/j.bjps.2025.11.061
Disciplines
Medicine and Health Sciences
PubMedID
41385814
Department(s)
Department of Surgery
Document Type
Article