Surgical management and outcomes of recurrent palatal fistulae: Insights from CLAPP's institutional experience.

BACKGROUND

Recurrent palatal fistulae pose a considerable challenge owing to prior failed repair, substantial scarring, and limited local tissue availability. These defects are particularly challenging to manage in low- and middle-income countries, where expertise and resources for cleft care may be limited. Furthermore, there remains a paucity of data focused specifically on patients presenting with recurrent palatal fistulae.

METHODS

A retrospective cohort study was conducted at CLAPP Hospital, Lahore (January 2022-December 2024), by including patients with at least one prior failed palatal fistula repair and ≥9 months of follow-up. Fistulae were classified using the Pakistan Fistula Classification Scheme. Surgical techniques were reviewed, and logistic regression analysis was performed to identify predictors of recurrence.

RESULTS

A total of 282 patients were included (mean age: 16.4 years). Fistula recurrence occurred in 63 patients (22.3%). Larger defects (>10 mm) and older age at the time of surgery were independently associated with increased recurrence risk (adjusted odds ratio [aOR] = 3.28, p = 0.043; aOR = 1.05, p = 0.004). The Bardach re-do palatoplasty was the most commonly used technique (56.0%), but it was associated with higher recurrence, reflecting its frequent use in more complex defects.

CONCLUSION

Recurrent palatal fistulae demand individualized, patient-centric surgical strategies. Older age and larger defect size significantly increase recurrence risk, underscoring the need for meticulous planning and selection of techniques that address scarring, vascularity, and local tissue limitations. These findings may inform management strategies, particularly in high-volume cleft centers within resource-constrained environments.