{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:12:03Z","timestamp":1791389523089,"version":"4.3.3"},"reference-count":29,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cleft lip and palate is the most frequent birth anomaly, with increasing reported rates of complications, such as palate fistulae. Current studies concerning the occurrence rate of cleft lip and palate (CLP) report 2 to 10 cases in 10,000 births. The purpose of this study was to investigate the existence of factors that could predict the occurrence of fistulae after cleft lip and palate surgery. A retrospective study was performed by collecting and analyzing data from all patients who were operated for cleft lip and\/or palate in the Maxillo-Facial Department of the Emergency Clinical County Hospital of Cluj-Napoca, Romania, between 2010 and 2020. We investigated the existing evidence for possible links between the number of fistulae observed after the primary palatoplasty and the age at which the primary palatoplasty was performed, the sex of the patient, the type of cleft, the timing of the surgical corrections, and the presence of comorbidities. A total of 137 cases were included for analysis. A significant link between the number of fistulae and the type of cleft was found (with fistulae occurring more frequently after the surgical correction of CLP\u2014p &lt; 0.001). No evidence was found for the existence of significant links between the number of fistulae and the patient\u2019s sex, the timing of surgery, or the presence of comorbidities. This study concluded that the incidence of palatal fistulae appears to be influenced by the type of cleft (CLP), but not by the sex of the patient, the timing of surgery, or the presence of comorbidities.<\/jats:p>","DOI":"10.3390\/ijerph18147305","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T04:32:49Z","timestamp":1625718769000},"page":"7305","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Evaluation of Prognostic Factors for Palatal Fistulae after Cleft Lip and Palate Surgery in a North-Western Romanian Population over a 10-Year Period"],"prefix":"10.3390","volume":"18","author":[{"given":"Daiana Antoaneta","family":"Opris","sequence":"first","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6123-4538","authenticated-orcid":false,"given":"Horia","family":"Opris","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Dinu","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simion","family":"Bran","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigore","family":"Baciut","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1087-8522","authenticated-orcid":false,"given":"Gabriel","family":"Armencea","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana","family":"Mitre","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9675-2893","authenticated-orcid":false,"given":"Horatiu Alexandru","family":"Colosi","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Baciut","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2011). IPDTOC Working Group Prevalence at Birth of Cleft Lip with or without Cleft Palate: Data from the International Perinatal Database of Typical Oral Clefts (IPDTOC). Cleft Palate-Craniofac. J., 48, 66\u201381.","DOI":"10.1597\/09-217"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.clp.2018.07.006","article-title":"Cleft Lip and Palate","volume":"45","author":"Worley","year":"2018","journal-title":"Clin. Perinatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1597\/06-204.1","article-title":"The Pittsburgh Fistula Classification System: A standardized scheme for the description of palatal fistulae","volume":"44","author":"Smith","year":"2007","journal-title":"Cleft Palate. Craniofac. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s12663-013-0535-2","article-title":"Palatal Fistulae: A Comprehensive Classification and Difficulty Index","volume":"13","author":"Richardson","year":"2014","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.oooo.2014.07.002","article-title":"Incidence of palatal fistula formation after primary palatoplasty in northern Finland","volume":"118","author":"Lithovius","year":"2014","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/1055665620931707","article-title":"Oronasal Fistula Risk After Palate Repair","volume":"58","author":"Pollard","year":"2021","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3389\/fphys.2016.00067","article-title":"Epidemiology, Etiology, and Treatment of Isolated Cleft Palate","volume":"7","author":"Burg","year":"2016","journal-title":"Front. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"041","DOI":"10.4103\/0970-0358.81447","article-title":"Descriptive study of management of palatal fistula in one hundred and ninety-four cleft individuals","volume":"44","author":"Murthy","year":"2011","journal-title":"Indian J. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/SCS.0000000000005852","article-title":"Outcomes of Surgical Management of Palatal Fistulae in Patients with Repaired Cleft Palate","volume":"31","author":"Denadai","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.4103\/jfmpc.jfmpc_472_20","article-title":"Cleft of lip and palate: A review","volume":"9","author":"Vyas","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1097\/SCS.0000000000006307","article-title":"Incidence of Fistula Formation and Velopharyngeal Insufficiency in Early Versus Standard Cleft Palate Repair","volume":"31","author":"Eliason","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/njms.NJMS_42_18","article-title":"A statistical analysis of incidence, etiology, and management of palatal fistula","volume":"10","author":"Garg","year":"2019","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1097\/00006534-199106000-00005","article-title":"Cleft palate fistulae: A multivariate statistical analysis of prevalence, etiology, and surgical management","volume":"87","author":"Cohen","year":"1991","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1097\/00006534-200111000-00011","article-title":"Incidence of cleft palate fistula: An institutional experience with two-stage palatal repair","volume":"108","author":"Muzaffar","year":"2001","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ijom.2016.09.019","article-title":"Cleft relapse and oronasal fistula after Furlow palatoplasty in infants with cleft palate: Incidence and risk factors","volume":"46","author":"Li","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1016\/j.bjps.2008.05.048","article-title":"Width of cleft palate and postoperative palatal fistula\u2014do they correlate?","volume":"62","author":"Parwaz","year":"2009","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Division palatine: Anatomie\u2014chirurgie phon\u00e9tique (2005). By Victor Veau, Chirurgien de l\u2019H\u01d2pital des Enfants assist\u00e9s, with the collaboration of Mme. S. Borel. Large 8vo. Pp. 568 + viii, with 786 illustrations. 1931. Paris: Masson et Cie. Fr. 140. Br. J. Surg., 20, 355.","DOI":"10.1002\/bjs.1800207829"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Nalabothu, P., Benitez, B.K., Dalstra, M., Verna, C., and Mueller, A.A. (2020). Three-Dimensional Morphological Changes of the True Cleft under Passive Presurgical Orthopaedics in Unilateral Cleft Lip and Palate: A Retrospective Cohort Study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9040962"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1597\/11-063","article-title":"The value of microbiological screening in cleft lip and palate surgery","volume":"49","author":"Thomas","year":"2012","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1597\/03-108.1","article-title":"The bacteriology of children before primary cleft lip and palate surgery","volume":"42","author":"Chuo","year":"2005","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1682","DOI":"10.1097\/GOX.0000000000001682","article-title":"Cleft palate fistula closure utilizing acellular dermal matrix","volume":"6","author":"Emodi","year":"2018","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"618e","DOI":"10.1097\/PRS.0000000000000548","article-title":"Fistula incidence after primary cleft palate repair: A systematic review of the literature","volume":"134","author":"Hardwicke","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"81","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_24","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1097\/PRS.0000000000004324","article-title":"Cleft Palate Repair: Description of an Approach, Its Evolution, and Analysis of Postoperative Fistulas","volume":"141","author":"Tse","year":"2018","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/PRS.0b013e3182910acb","article-title":"Prospective analysis of presurgical risk factors for outcomes in primary palatoplasty","volume":"132","author":"Mahoney","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","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_27","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.bjps.2018.08.019","article-title":"Determining postoperative outcomes after cleft palate repair: A systematic review and meta-analysis","volume":"72","author":"Stein","year":"2019","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/01.prs.0000220875.87222.ac","article-title":"Two-flap palatoplasty: 20-Year experience and evolution of surgical technique","volume":"118","author":"Salyer","year":"2006","journal-title":"Plast. Reconstr. Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/14\/7305\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:27:39Z","timestamp":1760164059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/14\/7305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,8]]},"references-count":29,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["ijerph18147305"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18147305","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,8]]}}}