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Cleft & Craniofacial Surgery

(5) Trends and Risk Factors for Secondary Surgeries After 800 Cleft Palate Repairs: A Single-Center Review

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT
Disclosure(s):
Melanie Bakovic, BS: No financial relationships to disclose
Raina K. Patel, BS: No financial relationships to disclose
Asli Pekcan, BS: No financial relationships to disclose
Valeria Mejia, BS: No financial relationships to disclose
Abstract:

Purpose: Patients undergoing cleft palate (CP) repair may require additional procedures for palatal fistulas, velopharyngeal insufficiency (VPI), and midface hypoplasia (1-2). 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 < .001), VPI surgeries (β = -0.395, P < .001), and orthognathic surgeries (β = -4.612, P < .001) significantly decreased despite a rising trend in CP repairs (β = 1.476, P < .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.

References:
1.Celie KB, Wlodarczyk J, Naidu P, et al. Sagittal Growth Restriction of the Midface Following Isolated Cleft Lip Repair: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J. 2024;61(1):20-32. doi:10.1177/10556656221116005
2.Abdel-Aziz M, El-Hoshy H, Ghandour H. Treatment of velopharyngeal insufficiency after cleft palate repair depending on the velopharyngeal closure pattern. J Craniofac Surg. 2011;22(3):813-817. doi:10.1097/SCS.0b013e31820f3691