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BACKGROUND: Fistula rates in cleft palate repair vary by technique, surgeon, and institution. A recent meta-analysis reports a fistula rate of 4.9%. Most agree that wider, more complete clefts have a higher rate of fistula formation than small incomplete clefts or a submucous cleft palate (SMCP). Furthermore, redo palate surgery likely has an even higher fistula rate. Although steroids are commonly used in airway surgery, many plastic surgeons are reluctant to use steroids in surgery where perfect or near perfect healing is paramount to successful outcomes, namely in cleft palate surgery.
METHODS: A retrospective review was done of all cleft palate surgeries performed by a single surgeon from 2010-2014. All patients with less than 90 days of postoperative follow up were excluded. Data reviewed in addition to demographics included type of cleft, steroid use (intraoperatively and/or postoperatively), length of surgery, length of stay, and rate of fistula formation.
RESULTS: 161 charts were reviewed, and 26 were excluded because of inadequate follow- up. 77 were male and 58 were female. Median age at surgery was 3.4 years (interquartile range 1.1-7.1). 57 patients had a Veau I - IV cleft and 65 had a SMCP. 13 clefts were redo or conversion palatoplasties. All patients underwent a furlow palatoplasty by the senior author; median length of surgery was 2.1 hours. In the Veau I-IV group, 45 received steroids; of the 4 patients who developed a fistula, 2 had received steroids and 2 had not. In the SMCP group, 46 received steroids, and 0 patients developed a fistula. In the conversion furlow/redo group, 10 received steroids and 0 patients developed a fistula. Overall fistula rate was less than 3%. There was no significant relationship between development of fistula and steroid use (p = 0.263, Fisher's exact test). The average number of doses of steroids was 2.3. The average length of stay in the hospital was 2.0 days in patients receiving steroids and 2.5 days in patients who did not receive steroids (p <0.05).
CONCLUSIONS: Steroid use in cleft palate surgery is safe and does not lead to wound healing complications. Given the length of stay in this cohort, it is possible that perioperative use of steroids decreases postoperative airway complications such as swelling and obstruction and lessens pain leading to shorter hospitalizations.