Pakistan Comprehensive Fistula Classification: A novel Scheme and Algorithm for management of palatal fistula/dehiscence

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 which do not describe the fistula details comprehensively and guide towards its management. We have come across wide variety of fistulae which 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, we have proposed an algorithm which encompasses clear guidelines for surgical treatment of these fistulae. Materials and Methods: Over the last 15 years, our team operated upon 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: Out of 2537 patients, 2258 patients had midline fistulae, 208 patients had lateral fistulae and 53 patients had subtotal fistulae. There were 18 patients with dehiscence. Recurrence developed in 181 patients. Conclusion: We believe that this classification and algorithm can help follow a practical approach to manage palatal fistulae and dehiscence. Financial Disclosure: None. ACKNOWLEDGMENT: We are grateful to Prof. Herman Sailer, Founder/Chairman of Cleft Children International, Zurich, Switzerland, for supervision and guidance of our Cleft Program in Pakistan & Afghanistan. ©2018American Society of Plastic Surgeons

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