Reducing the Development of Oronasal Fistulas: The Effect of Post-Operative Restrictions on Outcomes Following Palatoplasty

Purpose: Post-operative restrictions such as arm restraints (AR) and suction-less feeding are commonly used to decrease rates of oronasal fistulas after cleft surgery; however the utility of these restrictions remains unclear. We hypothesize that the use of arm restraints and suction-less feeding methods do not impact the rate of oronasal fistula development following palatoplasty. Methods: A retrospective case-control study identified clinical data for 105 primary palatoplasty patients from the multidisciplinary craniofacial clinics of 2 university hospitals from 2009 to 2020. Forty-nine patients underwent bottle feeds and did not have arm restraints (Limited Restrictions group, LR); 56 patients underwent suction-less feeding methods and used arm restraints (Highly Restricted group, HR). Primary outcomes included the rate of reoperations, post-operative length of stay (LOS), and the rate of oronasal fistula (ONF) development were compared. Results: The post-operative LOS for the LR and HR groups was 1.88 ± 0.81 days and 2.05 ± 1.33 days, respectively ( P = .42). The rate of post-operative ONF development was 5/49 (10.2%) and 4/56 (7.1%) for the LR and HR cohorts, respectively ( P = .73). There was no significant difference in the rate of reoperation between the LR and HR groups (LR: 5/49 [10.2%] vs HR: 2/56 [3.6%]; P = .24). The rate of oronasal fistula development did not vary by veau type or syndromic status. Conclusions: Our preliminary data suggest that restrictions do not impact the rate of oronasal fistula development in patients undergoing primary palatoplasty. Our findings also indicate that postoperative restrictions do not impact the rate of reoperation or LOS. In light of this, we recommend that practitioners reconsider the utility of highly restrictive post-operative protocols.