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| Name | Class |
|---|---|
| University of Lagos, Nigeria | OTHER |
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Palatal fistulas are a major burden to surgeons and patients in the management of cleft palate. Their high rate of occurrence and recurrence makes them particularly challenging even to the highly skilled surgeon. Prevention of postoperative palatal fistula is therefore of paramount importance.
Closure of the nasal mucosa under tension has been proposed as a major cause of palatal fistula formation. However, depending on the presentation of the cleft palate, it may be impossible to achieve surgical closure with minimal tension. Till date, there is no universally acceptable method of preventing palatal fistula formation following cleft palate repair. And although the use of pre-surgical appliances such as Latham appliance and the use of local and distant tissues to achieve two layer closure have been proposed, the use of a superpositional collagen graft may also be used to achieve closure of the nasal mucosa with minimal or no tension during cleft palate repair.
Collagen grafts have the added advantage of being more patient friendly compared to the Latham appliance which requires an initial surgery for appliance insertion before surgical cleft palate repair. They are also less technique sensitive compared to the use of local and distant tissues.
The investigators therefore aim to provide high level scientific evidence of the effectiveness of collagen graft in the prevention of postoperative palatal fistula.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Test group | Experimental | The intervention will be primary cleft palate repair using resorbable collagen matrix graft as superpositional graft during approximation of the nasal mucosa and muscular layer in cleft palate repair. The collagen graft with be inserted between the nasal mucosa/ muscular layer and the oral mucosa layer during two-flap palatoplasty. |
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| Control group | Active Comparator | The intervention will be primary cleft palate repair using two-flap palatoplasty technique without collagen graft |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Two-flap palatoplasty | Procedure | Two-flap palatoplasty used to correct cleft palate defect. The cleft palate is closed by separation of the nasal and the oral mucosa layers. Then approximation of the nasal mucosa layer, muscle layer is secured in the posterior palate and then the oral mucosa layer is secured |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with postoperative palatal fistula | Palatal fistula will be defined as a patency between the oral and nasal cavities developing postoperatively anywhere along the primary or secondary palate | 24 hours post operatively |
| Number of participants with postoperative palatal fistula | Palatal fistula will be defined as a patency between the oral and nasal cavities developing postoperatively anywhere along the primary or secondary palate | Seven days post operatively |
| Number of participants with postoperative palatal fistula | Palatal fistula will be defined as a patency between the oral and nasal cavities developing postoperatively anywhere along the primary or secondary palate | Two weeks post operatively |
| Number of participants with postoperative palatal fistula | Palatal fistula will be defined as a patency between the oral and nasal cavities developing postoperatively anywhere along the primary or secondary palate | One month post operatively |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with wound dehiscence | Wound dehiscence will be defined as partial or total separation of previously approximated and sutured surgical wound edges with or without palatal fistula formation. | 24 hours post operatively |
| Number of participants with wound dehiscence |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lagos University Teaching Hospital | Lagos | 12003 | Nigeria |
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| ID | Term |
|---|---|
| D002971 | Cleft Lip |
| D002972 | Cleft Palate |
| ID | Term |
|---|---|
| D008047 | Lip Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
| D009056 | Mouth Abnormalities |
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The study will be a parallel randomized controlled study involving two groups of participants. The test group will include participants with who will undergo cleft palate repair with collagen graft used as superpositional graft between the nasal mucosa/muscle layer and the oral mucosa layer when two-flap palatoplasty is performed while the control group will include participants who undergo two-flap palatoplasty without the use of collagen graft
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This study will be a double-blind randomized controlled study. After random allocation, the participants (parents/ patients) will be unaware of the study group they belong to. Also, the surgeon assessing postoperative outcomes will not perform the surgery and will be unaware of the study group of the participant being examined. Since the collagen graft will be placed between the nasal/ muscular layers and the oral layer, it is expected that after apposition of the oral layer, no collagen matrix will be visible intraorally to reveal the study group of participants.
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Wound dehiscence will be defined as partial or total separation of previously approximated and sutured surgical wound edges with or without palatal fistula formation. |
| Seven days post operatively |
| Number of participants with wound dehiscence | Wound dehiscence will be defined as partial or total separation of previously approximated and sutured surgical wound edges with or without palatal fistula formation. | Two weeks post operatively |
| Number of participants with wound dehiscence | Wound dehiscence will be defined as partial or total separation of previously approximated and sutured surgical wound edges with or without palatal fistula formation. | One month post operatively |
| Number of participants with surgical site inflammation | Surgical site inflammation will be defined as tenderness, redness, swelling and/or differential warmth from surgical site. | 24 hours post operatively |
| Number of participants with surgical site inflammation | Surgical site inflammation will be defined as tenderness, redness, swelling and/or differential warmth from surgical site. | Seven days post operatively |
| Number of participants with surgical site inflammation | Surgical site inflammation will be defined as tenderness, redness, swelling and/or differential warmth from surgical site. | Two weeks post operatively |
| Number of participants with surgical site inflammation | Surgical site inflammation will be defined as tenderness, redness, swelling and/or differential warmth from surgical site. | One month post operatively |
| Number of participants with surgical site infection | Surgical site infection will be defined as tenderness and purulent discharge and/or foul smelling odor from surgical site | 24 hours post operatively |
| Number of participants with surgical site infection | Surgical site infection will be defined as tenderness and purulent discharge and/or foul smelling odor from surgical site | Seven days post operatively |
| Number of participants with surgical site infection | Surgical site infection will be defined as tenderness and purulent discharge and/or foul smelling odor from surgical site | Two weeks post operatively |
| Number of participants with surgical site infection | Surgical site infection will be defined as tenderness and purulent discharge and/or foul smelling odor from surgical site | One month post operatively |
| Surgeon satisfaction | Surgeon satisfaction will assess surgeons' opinion on surgery time (normal/ extended), difficulty of procedure (not difficult/ increased difficulty) and inadvertent tearing of the nasal mucosa (absent/ present). | within the first 24 hours post operatively |
| D018640 |
| Stomatognathic System Abnormalities |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007569 | Jaw Abnormalities |
| D007571 | Jaw Diseases |
| D009140 | Musculoskeletal Diseases |
| D019767 | Maxillofacial Abnormalities |
| D019465 | Craniofacial Abnormalities |
| D009139 | Musculoskeletal Abnormalities |