The use of acellular dermal matrix in the closure of oronasal fistulae after cleft palate repair.

Abstract

Although the management of cleft lip and palate has improved significantly during the last years, repairing oronasal fistulae is still a challenge. Reports of the incidence of postoperative fistulae following palate repair range from 10% to 20%.1 Several techniques are reported for the treatment of oronasal fistula, such as local mucoperiosteal flap, V-Y 2-layer repair, superior lip mucosal or myomucosal flap, buccal myomucosal flap, superiorly based facial artery myomucosal flap, tongue flap, free flap, free cartilage graft, and distraction osteogenesis. The great number of different techniques is the demonstration that there is not any particular technique that provides satisfactory results. Usually, the fistula occurs at the junction of the hard and soft palate, a defect in this location is frequently associated with hypernasality of the speech, velopharyngeal incompetence, and nasal regurgitation of food and liquids with consequent impairment of the quality of life. Repair of existing fistula is also prone to failure because prior palatal surgery inevitably creates scars, altered vascularity, and tension.