Increased fistula risk following palatoplasty in Treacher Collins syndrome.
OBJECTIVE
Patients with Treacher Collins syndrome have abnormal vascular supply to the palate, yet it is unknown whether there are increased postoperative healing problems following palatoplasty. This study investigated the correlation between Treacher Collins syndrome and postoperative palatal fistula formation.


METHODS
Retrospective chart review was performed.


METHODS
Children undergoing palatoplasty at Children's Hospital Los Angeles from 1987 to 2000 were evaluated. Ten children with Treacher Collins syndrome, 92 children with other syndromes and cleft palate, and 458 nonsyndromic patients with isolated cleft palate were studied.


METHODS
All children were treated with a one-stage, double-reversing Z-plasty cleft palate repair.


METHODS
Outcome measures included intraoperative observations of surgical anatomy and postoperative clinic follow-up of fistula formation. Palatal fistula rates between patients with Treacher Collins syndrome, other syndromes, and no syndrome were compared with chi-square analysis.


RESULTS
Children with Treacher Collins syndrome had significantly greater palatal fistula rates (50%) than children with other syndromes (8.7%) or no syndrome (4.1%). Treacher Collins patients demonstrated large palatal fistulas and poor flap vascularity.


CONCLUSIONS
Children with Treacher Collins syndrome and cleft palate have significantly higher palatal fistula risk than other children with cleft palate when double-reversing Z-plasty palate repair is performed. Our findings suggest that children with Treacher Collins syndrome and cleft palate may have poor vascularity to palatal flaps created during palatoplasty. Furthermore, we recommend that surgeons performing palatoplasty minimize the dissection of mucoperiosteal flaps around the greater palatine arterial pedicle and utilize closure techniques creating the least vascular disruption of palatal tissue.
Division of Plastic Surgery, Childrens Hospital Los Angeles Cleft and Craniofacial Center, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. sdbresnick@aol.com
Stephen
S
Bresnick
John
J
Walker
Noreen
N
Clarke-Sheehan
John
J
Reinisch
D016009:Chi-Square Distribution; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008342:Mandibulofacial Dysostosis / Q000601:surgery*; D016155:Oral Fistula / Q000209:etiology*; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010159:Palate / Q000098:blood supply / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk