Predicting the Feasibility of Local Tissues in Recurrent Palate Fistula Repair: A New Scoring System.

Abstract

Objective: This study aimed to assess the impact of structural changes from repeated failed surgeries on outcomes and develop a scoring system to evaluate local palatal tissue usability in recurrent fistula repairs.

Design: A retrospective study of 51 patients with prior failed fistula surgeries using a novel scoring system for palatal tissue evaluation.

Setting: The study was conducted at a tertiary care center for craniofacial surgery.

Patients, participants: 51 patients with recurrent palatal fistulas and at least 1prior failed surgery were included. Standardized preoperative photographs were taken.

Interventions: Patients underwent palatal fistula repair. Outcomes were assessed 12 months postoperatively, and patients were grouped by success. Two surgeons applied the scoring system to assess scar condition (evaluated by color), rugae presence, remnant flap (RF), and number of failed surgeries (NFSs).

Main outcome measure(s): The primary measure was the correlation between scoring system criteria and surgical outcomes, with statistical analysis determining predictive value.

Results: All criteria correlated with NFS and recurrence (P < 0.001), but only rugae, RF, and NFS showed strong associations with recurrence. Scar condition evaluated by color had lower correlations with rugae (r = 0.461), RF (r = 0.458), and NFS (r = 0.239). The final scoring system was simplified to 3 variables: rugae, RF, and NFS.

Conclusions: The revised scoring system effectively predicts success in recurrent palatal fistula repairs. Scores above 2 indicate a high risk of recurrence, suggesting alternative approaches when using local tissues.