title: The Pittsburgh Fistula Classification System: a standardized scheme for the description of palatal fistulas.
abstract: OBJECTIVE
  Vague terminology is a problem in cleft palate research. No classification scheme for palatal fistulas has been proposed to date. Although a well-healed velum is a significant outcome of palatoplasty, it is nearly impossible to compare fistula-related palatoplasty results in the literature or in medical records without a standardized vocabulary. We endeavor to devise a palatal fistula classification system that may have clinical and research applicability.
  
  
  METHODS
  PubMed was searched for definitions and classifications of palatal fistula as well as incidence and recurrence rates of this outcome. Next, a 25-year retrospective review of our Cleft Center's records was performed, and fistulas were identified (n=641 charts reviewed). The fistula descriptions yielded by this chart review were evaluated in the context of anatomical descriptions in the literature, and a clinician-friendly classification scheme was designed.
  
  
  RESULTS
  A literature review failed to reveal a standardized fistula classification system. An anatomically based numerical fistula classification system was devised: type I, bifid uvula; type II, soft palate; type III, junction of the soft and hard palate; type IV, hard palate; type V, junction of the primary and secondary palates (for Veau IV clefts); type VI, lingual alveolar; and type VII, labial alveolar.
  
  
  CONCLUSIONS
  We propose a standardized numerical classification system for palatal fistulas. Its clinical adoption may prospectively clarify ambiguities in the literature and facilitate future cleft palate research and clinical practice.
authors.affiliation: Children's Hospital of Pittsburgh, Division of Pediatric Plastic Surgery, and Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, PA 15213, USA.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Smith
authors.forename: Lisa
authors.initials: L
authors.lastname: Vecchione
authors.forename: Shao
authors.initials: S
authors.lastname: Jiang
authors.forename: Matthew
authors.initials: M
authors.lastname: Ford
authors.forename: Frederic W B
authors.initials: FW
authors.lastname: Deleyiannis
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Haralam
authors.forename: Sanjay
authors.initials: S
authors.lastname: Naran
authors.forename: Christine I
authors.initials: CI
authors.lastname: Worrall
authors.forename: Jason R
authors.initials: JR
authors.lastname: Dudas
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Afifi
authors.forename: Mary L
authors.initials: ML
authors.lastname: Marazita
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
mesh_terms: D002972:Cleft Palate / Q000145:classification*; D006801:Humans; D016155:Oral Fistula / Q000145:classification*; D012189:Retrospective Studies; D009626:Terminology as Topic