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Pakistan Comprehensive Fistula Classification

A Novel Scheme and Algorithm for Management of Palatal Fistula/Dehiscence

Fayyaz, Ghulam Qadir, M.B.B.S., D.S.S., M.S.; Gill, Nauman Ahmad, M.R.C.S., F.C.P.S.; Ishaq, Irfan, M.B.B.S.; Aslam, Muhammad, M.B.B.S., F.C.P.S; Chaudry, Ayesha, M.B.B.S., F.C.P.S; Ganatra, Muhammad Ashraf, M.B.B.S., M.S.; Obaid, Obaidullah, F.R.C.S; Tarar, Moazzam Nazeer, F.R.C.S; Chen, Philip Kuo-Ting, M.D.; Laub, Donald Rudolph, M.D.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 140e–151e
doi: 10.1097/PRS.0000000000005169
Pediatric/Craniofacial: Original Articles

Background: It is not easy to find a management-based classification of palatal fistula in the literature. A few attempts have been made to classify the wide variety of fistulae that do not describe the fistula details comprehensively and guide toward its management. The authors have come across a wide variety of fistulae that could not be classified according to any of the prevailing classification systems. The presented classification gives a clear and exact understanding of location and size of fistula/dehiscence. Palatal function has been included as one of the important determinants for devising a management plan. Based on this classification, the authors have proposed an algorithm that encompasses clear guidelines for surgical treatment of these fistulae.

Methods: Over the past 15 years, the authors’ team operated on 2537 palatal fistula patients. The medical records of these patients were reviewed to determine the location, size, and velopharyngeal competence. A new classification and algorithm were developed.

Results: Of 2537 patients, 2258 had midline fistulae, 208 had lateral fistulae, and 53 had subtotal fistulae. There were 18 patients with dehiscence. Recurrence developed in 181 patients.

Conclusion: The authors believe that this classification and algorithm can help follow a practical approach to manage palatal fistulae and dehiscence.

Lahore, Punjab, Karachi, and Peshawar, Pakistan; Taipei, Taiwan; and Stanford, Calif.

From the Services Institute of Medical Sciences; Dow University of Health Sciences; North West Hospital; Jinnah Burns and Reconstructive Surgery Center; Taipei Medical University Hospital; and Stanford University.

Received for publication October 18, 2017; accepted May 25, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Ghulam Qadir Fayyaz, M.B.B.S., D.S.S., M.S., Department of Plastic Surgery, Services Institute of Medical Sciences and CLAPP Hospital, 932-C, Faisal Town, Maulana Shaukat Ali Road, Lahore, Punjab 54700, Pakistan, gqfayyaz@hotmail.com

©2019American Society of Plastic Surgeons