Large Anterior Oronasal Fistula with Short Palate: New Technique for Fistula Closure and Palatal Lengthening

Abstract

Background: Oro-nasal fistulae (ONF) is considered oneof the commonest sequelae of cleft palate repair. Fistulae closurecan represent a simple procedure or a great challenge.Usually, it is not easy to close large ONF using adjacent localtissues, which necessitates the displacement of tissues fromnearby anatomical regions.Objective: Evaluation of a new technique for fistula closureand palatal lengthening in ONF.Patients and Methods: Between the period of 2017 to 2020this prospective study was performed on seven cases with largeanterior ONF underwent surgical repair using bilateral BuccinatorMyomucosal Flaps (BMMF), one acts as a second layerfor fistula closure and the second one added more length to thepalate. Patient evaluation was based on clinical evaluation forfistulas recurrence, speech intangibility using Intelligibility inContext Scale (ICS) which performed preoperatively and oneyear post-operatively, and improvement of nasal regurgitation.Results: Seven non syndromic cases with large anteriorONF were included in this study of them five females and twomales with mean age (7.57±1.90) underwent fistula closurewith our new technique. On postoperative follow-up one case(14.3%) complicated with oral layer disruption that resolvedconservatively, also two cases (28.6%) suffered from chestinfection which required prolonged hospitalization. Improvementof nasal regurgitation, with no fistula recurrence occurin all seven cases. Assessment of speech intelligibility wasdone using Intelligibility in Context Scale (ICS) showing that(71.4%) were improved to score >3.5 which means that theirspeech is usually to sometimes understood to others.Conclusion: The use of our new technique is a reliablemethod that may be used for large anterior ONF closure andlengthening of short scarred palate with few drawbacks andmultiple benefits.