Closure of palatal fistula with a local mucoperiosteal flap lined with buccal mucosal graft

Objective: Oro-nasal fistula is a common complication of palatoplasty. Curr ent methods for fistula repair utilize mucoperiosteal flaps or pedicled fla ps. These procedures are often cumbersome and leave a raw nasal surface, wh ich may increase the incidence of postoperative risks and problems. In addi tion, the recurrence rate of the fistula is as high as 34%, We propose a si mple two-layer method of fistula repair to avoid recurrences. Design: A standard mucoperiosteal flap is raised on the oral side. A buccal mucosal graft is harvested from the cheeks and sutured to the nasal side o f the flap that is then inset into the fistula, Setting: Patients were either referred to the senior author's private pract ice (four patients) or were patients who had previously been operated on by the senior author himself (three patients). Subjects: Study subjects consisted of seven patients, four males and three females, ages 14 months to 8 years. All patients had previously undergone c left palate repair, complicated by subsequent oro-nasal fistula formation. Interventions: All patients underwent oro-nasal fistula repair under genera l anesthesia with a local mucoperiosteal flap lined with buccal mucosal gra fts placed on the nasal side of the flap. Results: In all cases, the fistula was completely closed at first attempt w ithout complications. Patients were followed for a minimum of 2 years, with out evidence of recurrence. Conclusions: Our proposed surgical procedure for fistula closure using a st andard mucoperiosteal flap lined with a buccal mucosal graft is a suitable alternative for the repair of postpalatoplasty oro-nasal fistulas, Further study and long-term follow-up is needed to establish this method as a new s tandard form of repair.