The Pittsburgh Fistula Classification System: a standardized scheme for the description of palatal fistulas.
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.
Smith
Darren M
DM
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.
Vecchione
Lisa
L
Jiang
Shao
S
Ford
Matthew
M
Deleyiannis
Frederic W B
FW
Haralam
Mary Ann
MA
Naran
Sanjay
S
Worrall
Christine I
CI
Dudas
Jason R
JR
Afifi
Ahmed M
AM
Marazita
Mary L
ML
Losee
Joseph E
JE
D002972:Cleft Palate / Q000145:classification*; D006801:Humans; D016155:Oral Fistula / Q000145:classification*; D012189:Retrospective Studies; D009626:Terminology as Topic