Use of Limberg flap double layered palatoplasty in the closure of acquired oro-nasal fistula in adults – A series of 7 cases with 6 months follow-up

Abstract

ObjectiveOronasal fistula (ONF) is an abnormal communication between the oral and nasal cavity. It may arise in consequence to iatrogenic injury, neoplasms, trauma or following cleft palate repair. Closure of palatal fistula can be achieved by local and regional flaps. These procedures are often cumbersome and leave a raw nasal/oral surface which may increase the incidence of postoperative problems. The reported recurrence rate of the fistula is between 37% - 65%. The present paper demonstrates the versatility of the rhomboid flap in the closure of ONF in a two-layered fashion to avoid recurrence and donor site morbidity. MethodsSeven patients (male, 6; female, 1) underwent reconstruction with Limberg flap for traumatic oronasal fistula of size less than 15 mm in its greatest dimension. The mucoperiosteum was first elevated gently and inverted to close the nasal side as a hinged flap, followed by the Limberg rhomboid flap, raised from one corner of the defect to provide tension-free closure of the oral surface. ResultsThe fistula was completely closed in all cases at the first attempt, without any peri- operative complications. All fistulas successively healed, and none of our patients developed any significant postoperative bleeding, infection or fistula recurrence during the entire follow-up period of 6-9 months. ConclusionThis study elucidates that Limberg flap procedure can be performed for managing oronasal fistula with a low complication rate, short hospital stays, and good long-term results. It can be used as an alternative to the existing conventional techniques in the closure of ONF.