What Is a Fistula After Cleft Palate Repair?
A fistula is one of the most common complications after palate repair. Here is what parents should know.
A fistula is an abnormal opening that can develop after cleft palate repair. It is a hole that connects the mouth to the nasal cavity that was not completely closed during surgery.
- How common is it:
- Occurs in about 5β15% of cleft palate repairs
- More common in wide clefts and bilateral clefts
- Less common with experienced surgeons
- What causes it:
- Tension on the suture line
- Poor blood supply to the tissue
- Infection
- Trauma to the palate during healing
- Wide clefts with limited tissue
- What does it look like?
- A small hole in the palate, usually at the junction of the hard and soft palate
- Sometimes may be very small and hard to see
- Food and liquids can pass from the mouth to the nose
- Problems it can cause:
- Food and liquid coming out of the nose
- Hypernasal speech (air leaks through the nose)
- Nasal regurgitation when drinking
- Ear infections
Treatment
- Small fistulas:
- Some close on their own during healing
- Some are small and may not need treatment
- Speech may not be affected if the fistula is tiny
- Larger fistulas:
- Require surgical repair (fistula closure)
- Usually performed 6β12 months after the initial repair
- May need a small flap of tissue from the mouth or tongue
- The success rate for repair is about 80β90%
Clinical Guidance
A fistula is an opening that can occur after cleft palate repair. It causes food and air to leak into the nose. Small fistulas may not need treatment, but larger ones require a secondary surgical repair. Your cleft team will monitor for this at follow-up visits.