Outcomes of cleft palate surgeries at the National Orthopaedic Hospital, Enugu, Nigeria: November 2008 – November 2013

Abstract

Background: Despite an increase in the number of palatoplasty procedures at the National Orthopaedic Hospital Enugu (NOHE) sequel to a partnership with Smile Train, no reports on subsequent outcomes have been published. We investigated the speech outcomes and rates of fistula formation, the relationship between introduction of solids and incidence of post-operative oronasal fistulae and the benefits of post-operative honey licks.

Objective: To determine the outcome of palatal repairs performed at our center in relation to the timing and nature of post-operative feeds.

Method: This was a cohort study of patients who had palatoplasty over a five-year period and were subsequently followed up for a maximum period of 9 years. The patient’s present condition, timing of first feeds, onset of solid feeds, honey licks, frequency of wound dehiscence, fistula formation, and speech outcomes were assessed. The evaluation for a fistula was made from two weeks after the surgery by a senior resident in plastic surgery. Analysis was done using SPSS version 21.0 and p value set at <0.05.

Results: A total of 115 surgeries: 90 primary cleft palate repairs, 6 combined cleft lip and palate surgeries and 19 secondary cleft palate repairs were done. Male to female ratio was 1:1.3. Age range of patients was 6 weeks to 36 years. Timing of introduction of solid meals significantly affected incidence of repair breakdown; and 58% had normal to near-normal speech.

Conclusions: Licking honey was associated with fewer wound breakdowns. Early return to solid feeds is associated with a higher incidence of wound breakdown following palate repair.