{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:00:45Z","timestamp":1760241645221,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T00:00:00Z","timestamp":1530662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: One of the potential complications of surgery for velopharyngeal insufficiency (VPI) is postoperative oral-nasal fistula (ONF). Reported rates vary from 0 to 60%. Several factors are on account of these disproportionate rates. Objective: The purpose of this study was to describe the use of a palatal protective stent (PPS) to preserve the VPI repair surgical site and to study its effectiveness for decreasing the incidence of postoperative ONF. Materials and Methods: A retrospective study was carried out. All patients undergoing surgery for VPI with complete preoperative and postoperative evaluations including at least one year follow up after surgery from 2012 to 2016 were studied. Some of the patients were operated on using a pre-molded palatal protective stent (PPS). Twenty-seven patients were included in the study group. Most of the patients underwent a customized pharyngeal flap according to findings of imaging procedures. The remaining cases underwent a Furlow palatoplasty. Twelve patients were operated on using PPS. Results: There were no surgical complications during the procedures. ONF was detected in four of the patients operated on without PPS. None of the patients undergoing surgery using PPS demonstrated ONF. All fistulas were located at the soft\/hard palate junction. VPI was corrected in 92% of the cases. Conclusion: Although only a reduced number of cases were studied, these preliminary results suggest that using PPS during surgical procedures for correcting VPI is a safe and reliable tool for preventing ONF.<\/jats:p>","DOI":"10.3390\/dj6030029","type":"journal-article","created":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T12:23:02Z","timestamp":1530706982000},"page":"29","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Palatal Protective Stents Prevent Oro-Nasal Fistulas after Surgery for Velopharyngeal Insufficiency: A Preliminary Report"],"prefix":"10.3390","volume":"6","author":[{"given":"Kongkrit","family":"Chaiyasate","sequence":"first","affiliation":[{"name":"Ian Jackson Craniofacial and Cleft Palate Clinic of Beaumont Hospital, Royal Oak, MI 48073, USA"},{"name":"Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pablo Antonio","family":"Ysunza","sequence":"additional","affiliation":[{"name":"Ian Jackson Craniofacial and Cleft Palate Clinic of Beaumont Hospital, Royal Oak, MI 48073, USA"},{"name":"Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5919-9868","authenticated-orcid":false,"given":"John","family":"Spolyar","sequence":"additional","affiliation":[{"name":"Ian Jackson Craniofacial and Cleft Palate Clinic of Beaumont Hospital, Royal Oak, MI 48073, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafaella","family":"Genova","sequence":"additional","affiliation":[{"name":"Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Andrade","sequence":"additional","affiliation":[{"name":"Ian Jackson Craniofacial and Cleft Palate Clinic of Beaumont Hospital, Royal Oak, MI 48073, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,7,4]]},"reference":[{"unstructured":"Dieffenbach, J.F. (1837). Practical Surgery, John Churchill.","key":"ref_1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"852e","DOI":"10.1097\/PRS.0000000000000184","article-title":"Cleft Palate Repair and Velopharyngeal Dysfunction","volume":"133","author":"Hopper","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1001\/archotol.133.3.224","article-title":"Quality of life in children with velopharyngeal insufficiency","volume":"133","author":"Barr","year":"2007","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_4","first-page":"62","article-title":"Velopharyngeal competence and primary cleft palate surgery, 1960\u20131971: A critical review","volume":"10","author":"Morris","year":"1973","journal-title":"Cleft Palate J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.bjps.2014.12.011","article-title":"A survey of assessment and management of velopharyngeal incompetence (VPI) in the UK and Ireland","volume":"68","author":"Hodgins","year":"2015","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1001\/jamafacial.2014.1436","article-title":"Risk of persistent palatal fistula in patients with cleft palate","volume":"17","author":"Ahmed","year":"2015","journal-title":"JAMA Facial Plast. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1597\/14-127","article-title":"The rate of oronasal fistula following primary cleft palate surgery: A meta-analysis","volume":"52","author":"Bykowski","year":"2015","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/00006534-197810000-00006","article-title":"Early non\u2014Surgical of postoperative palatal fistulae","volume":"62","author":"Berkman","year":"1978","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1097\/SCS.0000000000003616","article-title":"Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty","volume":"28","author":"Lee","year":"2017","journal-title":"J. Craniofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1097\/SCS.0000000000003653","article-title":"Fibrin Tissue Sealant as an Adjunct to Cleft Palate Repair","volume":"28","author":"Wu","year":"2017","journal-title":"J. Craniofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"196240","DOI":"10.1155\/2015\/196240","article-title":"Current controversies in diagnosis and management of cleft palate and velopharyngeal insufficiency","volume":"2015","author":"Ysunza","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ijporl.2016.08.006","article-title":"Velopharyngeal videofluoroscopy: Providing useful information in the era of reduced dose radiation and safety","volume":"89","author":"Ysunza","year":"2016","journal-title":"Int. J. Pediatr. Otorhinolryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/00006534-198678060-00002","article-title":"Cleft palate repair by double opposing Z-plasty","volume":"78","author":"Furlow","year":"1986","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","first-page":"528","article-title":"Uber eine neue methode der staphylorraphies","volume":"19","author":"Schoenborn","year":"1876","journal-title":"Arch. Klin Chir."},{"unstructured":"Guyuron, B. (2009). Plastic Surgery, Saunders Elsevier.","key":"ref_15"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1097\/01.PRS.0000085599.84458.D2","article-title":"A technique for cleft palate repair","volume":"112","author":"Sommerlad","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.fsc.2016.06.016","article-title":"Velopharyngeal dysfunction and treatment","volume":"24","author":"Meier","year":"2016","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.bjps.2015.05.014","article-title":"Redo double-opposing Z-plasty is effective for correction of marginal velopharyngeal insufficiency","volume":"68","author":"Hsu","year":"2015","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ijporl.2013.11.007","article-title":"Persistent oro-nasal fistula after primary cleft palate repair: Minimizing the rate via a standardized protocol","volume":"78","author":"Winters","year":"2014","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ajoms.2011.05.002","article-title":"Role of Fibrin Glue in palatoplasty to prevent formation of oro-nasal fistula\u2014An in vivo study","volume":"23","author":"Basha","year":"2011","journal-title":"Asian J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/00006534-197808000-00004","article-title":"Impressions of Charles Stent","volume":"62","author":"Mulliken","year":"1978","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_22","first-page":"168","article-title":"Velopharyngeal dysfunction. Diagnosis and Management","volume":"7","author":"Ysunza","year":"2008","journal-title":"J. Maxillofac. Oral Surg."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/6\/3\/29\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:11:13Z","timestamp":1760195473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/6\/3\/29"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,4]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,9]]}},"alternative-id":["dj6030029"],"URL":"https:\/\/doi.org\/10.3390\/dj6030029","relation":{},"ISSN":["2304-6767"],"issn-type":[{"type":"electronic","value":"2304-6767"}],"subject":[],"published":{"date-parts":[[2018,7,4]]}}}