Oral Health–Related Quality of Life and Self-Rated Speech in Children with Existing Fistulas in Midchildhood and Adolescence

Objective To report the associations of oro-nasal fistulae on the patient-centered outcomes oral health–related quality of life and self-reported speech outcomes in school aged children. Design Prospective, nonrandomized multicenter design. Setting Six American Cleft Palate–Craniofacial Association-accredited cleft centers. Participants Patients with cleft palate at the age of mixed dentition. Interventions None. Main Outcome Measures Prevalence of fistula and location of fistula (Pittsburgh Classification System). Patients were placed into one of three groups based on the following criteria: alveolar cleft present, no previous repair (Group 1); alveolar cleft present, previously repaired (Group 2); no congenital alveolar cleft (Group 3). Presence of fistula and subgroup classification were correlated to oral health-related quality of life (Child Oral Health Impact Profile [COHIP]) and perceived speech outcomes. Results The fistula rate was 5.52% (62 of 1198 patients). There was a significant difference in fistula rate between the three groups: Group 1 (11.15%), Group 2 (4.44%), Group 3 (1.90%). Patients with fistula had significantly lower COHIP scores ( F 1,1188 = 4.79, P = .03) and worse self-reported speech scores ( F 1,1197 = 4.27, P = .04). Group 1 patients with fistula had the lowest COHIP scores ( F 5,1188 = 4.78, P = .02) and the lowest speech scores ( F 5,1188 = 3.41, P = .003). Conclusions Presence of palatal fistulas was associated with lower oral health-related quality of life and perceived speech among youth with cleft. The poorest outcomes were reported among those with the highest fistula rates, including an unrepaired alveolar cleft.