4. Reducing Fistula: A Retrospective Cohort Study of 1000 Cleft Palate Repairs by a Single Surgeon
Bibliographic record
Abstract
PURPOSE: Fistula is a significant complication following cleft palate repair. However, the incidence of fistula varies considerably with high rates still frequently reported. This study demonstrates techniques that reduce the rate of fistula formation and exemplifies the minimization of its incidence using a single surgeon’s experience. METHODS: A retrospective review of prospectively collected data of patients who underwent cleft palate repair by a single surgeon was performed. Techniques involved meticulous handling of tissue in particular along the medial oral and nasal mucosal edges. Nasal mucosal release involved elevation of the mucosa from the medial pterygoid plate and hard palate and division of the tensor to offload tension during nasal mucosal closure. The type of cleft palate and technique performed as well as the incidence and size of post-operative fistula was determined. RESULTS: The surgeon performed 1000 consecutive cleft palate repairs. A Furlow was performed 103 and 48 times for all Veau I and submucous cleft palates, respectively. Straight line repairs involved 384 von Langenbeck palatoplasty’s for Veau II, 297 Hybrid repairs for Veau III and 167 three flap repairs for Veau IV cleft palates. There were 9 post-operative fistulas following straight line repairs (incidence of 0.9%). Eight of the 9 fistulas were 2.5 mm or less in size. There were no post-operative fistulas following Furlow palatoplasty. CONCLUSION: This study demonstrates a very low fistula rate with a large series of patients. Meticulous tissue handling as well as extensive release of the mucosa during palatoplasty minimizes the risk of post-operative fistula.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".