{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:20:30Z","timestamp":1791670830381,"version":"4.3.4"},"reference-count":60,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Oronasal fistula (ONF) rates after primary palatoplasty may be influenced by technique improvements and care expansion. We evaluated the temporal and geospatial patterns of ONF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were performed of publications between January 1960 and November 2024 that reported fistula rate following cleft palate repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Patients with cleft palate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Primary palatoplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure(s)<\/jats:title>\n                    <jats:p>Fistula rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>223 publications with 71,238 patients were included. Median fistula rates decreased from the 1960s (13.9%, n\u2009=\u20092) to the 2000s (4.9%, IQR: 2.9%-11.0%). Fistula rates increased significantly in the 2010s (6.7%, IQR: 2.6\u201314.0%), and continued to increase in the 2020s (10.7%, IQR: 5.7\u201320.5%, p\u2009=\u20090.005). Fistula rates among European nations showed the largest increase from the 2000s (4.4%, IQR: 2.0\u201312.5%) to the 2020s (21.1%, IQR: 12.7\u201349.4%, p\u2009=\u20090.041).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Reported fistula incidence declined from reports in the 1960s through the 2000s but has since increased.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656251382537","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T18:13:09Z","timestamp":1759515189000},"page":"2626-2634","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Global Increase in Oronasal Fistula Rates Following Cleft Palate Repair: A Systematic Review and Meta-Analysis of Reported Fistula Rates"],"prefix":"10.1177","volume":"63","author":[{"given":"Isabel A.","family":"Ryan","sequence":"first","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1410-9931","authenticated-orcid":false,"given":"Nicholas A.","family":"Han","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley E.","family":"Chang","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin B.","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D.","family":"Tolley","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison C.","family":"Hu","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oksana A.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2310-3659","authenticated-orcid":false,"given":"Scott P.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7112-8114","authenticated-orcid":false,"given":"Jordan W.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199106000-00005"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211026861"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619829388"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221116534"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198704000-00001"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620981331"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1597\/13-282"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/sap.0000000000000819"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200111000-00011"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198678060-00004"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211046810"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1597\/09-069"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2008.05.048"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199705010-00010"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_1999_036_0073_ltoaot_2.3.co_2"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2391(88)90044-4"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2015.07.035"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/02844310510006529"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0007-1226(62)80062-9"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2395-9"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1597\/10-146"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000000548"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-204.1"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000005169"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1597\/14-127"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000000186"},{"key":"e_1_3_3_28_2","unstructured":"Operation Smile. presented at: NeXT Conference; 2015; Virginia Beach Virginia."},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coms.2020.04.010"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1876-6"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000008334"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32335-3"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620974562"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665618774028"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619856243"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00136"},{"key":"e_1_3_3_37_2","unstructured":"The World by Income. The World Bank. https:\/\/datatopics-worldbank-org.proxy.library.upenn.edu\/world-development-indicators\/the-world-by-income-and-region.html."},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(95)00134-4"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/scs.0000000000006307"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31829ad109"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665618802150"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2000_037_0506_teohfo_2.0.co_2"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2024.04.058"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000011197"},{"issue":"10","key":"e_1_3_3_46_2","first-page":"628","article-title":"Comparison of speech results after furlow palatoplasty and von langenbeck palatoplasty in incomplete cleft of the secondary palate","volume":"24","author":"Yu CC","unstructured":"Yu CC, Chen PK, Chen YR. Comparison of speech results after furlow palatoplasty and von langenbeck palatoplasty in incomplete cleft of the secondary palate. Chang Gung Med J. Oct 2001;24(10):628-632.","journal-title":"Chang Gung Med J"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2002_039_0226_mttscp_2.0.co_2"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620923925"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2001_038_0020_clapci_2.0.co_2"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2001_038_0024_clapci_2.0.co_2"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.Prs.0000085599.84458.D2"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31823aea7e"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1597\/16-007"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000005843"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000005210"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221148901"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1177\/019459989411100115"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.3109\/2000656x.2012.668774"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221117930"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000000391"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2011.09.015"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656251382537","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656251382537","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656251382537","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:24:18Z","timestamp":1783423458000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656251382537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":60,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/10556656251382537"],"URL":"https:\/\/doi.org\/10.1177\/10556656251382537","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}