title: Fistula incidence after primary cleft palate repair: a systematic review of the literature.
abstract: BACKGROUND
  The development of an oronasal fistula after primary cleft palate repair has a wide variation reported in the literature. The aim of this review is to identify the reported oronasal fistula incidence to provide a benchmark for surgical practice.
  
  
  METHODS
  A systematic review was undertaken to investigate the incidence of fistula. Multiple meta-analyses were performed to pool proportions of reported fistulae, in each data set corresponding to the continent of origin of the study, type of cleft, and techniques of cleft palate repair used.
  
  
  RESULTS
  A total of 9294 patients were included from 44 studies. The overall incidence of reported fistula was 8.6 percent (95 percent CI, 6.4 to 11.1 percent). There was no significant difference in the fistula incidence corresponding to the continent of origin of each study or the repair technique used. The incidence of fistula in cleft lip-cleft palate was 17.9 percent, which was significantly higher (p = 0.03) than in cases of cleft palate alone (5.4 percent).
  
  
  CONCLUSIONS
  Palatal fistulae were more likely to occur in cases of combined cleft lip-cleft palate, compared with cleft palate alone. The authors would recommend the prospective examination and recording of all fistulae to a standardized classification scheme.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Birmingham, United Kingdom From the Department of Plastic Surgery, Birmingham Children's Hospital NHS Foundation Trust; and the School of Dentistry, University of Birmingham.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hardwicke
authors.forename: Gabriel
authors.initials: G
authors.lastname: Landini
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Richard
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D006801:Humans; D015994:Incidence; D009668:Nose Diseases / Q000453:epidemiology*; D016155:Oral Fistula / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D016156:Respiratory Tract Fistula / Q000453:epidemiology*