Hard Palate Fistula Research Articles

Impact of a Palatal Fistula After Cleft Palate Repair on Velopharyngeal Closure.

A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency. A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction. Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, P < .001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, P = .757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤P ≤ .975). A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction.

Closure of fistula of the hard palate with two layers of mucoperiosteum

ObjectiveOronasal fistula represents a functional problem, as it may result in nasal regurgitation of food and fluids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high recurrence rate. The aim of this study was to assess the efficacy of closure of hard palate fistula by two layers of mucoperiosteal flaps. MethodsEighteen patients with fistula of the hard palate were included. The fistula was repaired by two layers of mucoperiosteal flaps; the first layer was created from the mucoperiosteum surrounding the fistula as bilateral hinge flaps and the second layer was formed of a rotational flap based on the greater palatine artery. Pre- and postoperative clinical assessment was performed. ResultsThe etiology of fistulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3 patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal regurgitation and hypernasal speech. Complete closure of all fistulas was achieved at first attempt, with no recurrence through the follow up period. ConclusionsClosure of oronasal fistula by two layers of mucoperiosteal flaps is an effective method and it has neither complications nor recurrence.

The facial artery musculomucosal flap in the reconstruction of the cocaine-induced hard palate fistula

The versatility of the facial artery musculomucosal (FAMM) flap has been employed in the reconstruction of a number of defects in the head and neck region. Closure of the cocaine-induced palatal fistula is complex, in particular because of the poor quality local tissue. To date, the FAMM flap has yet to be reported in this situation. We describe our experience with one such case, detailing our rationale for choosing the FAMM flap, intra-operative technique, and recommendations for other surgeons with similar cases. Level of Evidence: Level V, therapeutic study.

A retained iatrogenic foreign body in nasal cavity presenting with a hard palatal fistula

A 30-year-old male presented with a hard palate fistula. He had a history of faciomaxillary injury 8 months back. He had nasal regurgitation after the injury. He had severe halitosis at the time of presentation. A large foam piece was removed through the fistula under general anesthesia. There was a lack of documentation regarding the placement of foam piece as a nasal pack during initial treatment. A need of good documentation of the removal of the foreign body is emphasized.

V–Y two-layer repair for oronasal fistula of hard palate

Objective Oronasal fistula represents a functional problem after cleft palate repair; its closure is technically difficult with a high recurrence rate after primary treatment. The aim of this study was to evaluate the efficacy of closure of oronasal fistula using 2 layers of oral mucoperiosteum in a V–Y manner. Methods Fourteen patients were subjected for repair of their oronasal fistulas using 2 layers; the first is the oral mucoperiosteum that is elevated and inverted to close the nasal side as a hinge flap, and the second is also the oral mucoperiosteum that is elevated and sutured in a V–Y manner to close the oral side. Results In all cases, the fistula was completely closed at first attempt, no cases developed operative or postoperative complications. Recurrence with not recorded in any case after a follow-up period of at least 12 months. Conclusion Closure of oronasal fistula of the hard palate that may develop after cleft palate repair using a two-layer closure in V–Y manner is an easy and ideal method with a high success rate.

Superiorly Based Facial Artery Musculomucosal Flap for Large Anterior Palatal Fistulae in Clefts

An anterior hard palate fistula for which more than one attempt at repair using local tissue has failed is a difficult complication in cleft surgery. Prior to alveolar bone grafting, cleft patients have an open anterior maxillary arch that allows passage of a pedicled flap from cheek to hard palate. The superiorly based facial artery musculomucosal flap passed through the clefted alveolus is one of the newer techniques to solve this difficult problem. The aim of this study was to assess the validity of using a facial artery musculomucosal flap with an anterosuperiorly based pedicle with retrograde blood flow to repair a large anterior hard palate fistula when a lack of adequate local soft tissue precludes a local flap closure and the patient otherwise would need a tongue flap. Of 16 facial artery musculomucosal flaps in 14 children, 12 were successful, 2 suffered partial flap loss secondary to venous congestion, and 2 had complete flap failure. One had a small wound dehiscence that resulted in a small posterior fistula. An anterosuperiorly based facial artery musculomucosal flap is a viable option to close large anterior hard palate defects. Care needs to be taken to ensure adequate venous drainage. This flap obviates the need for a staged tongue flap repair for those patients with an open maxillary arch.

Congenital palatal fistula: an embryological enigma?

Cleft palate can present in varying degrees of severity. Based on the development of the palate, the minimal expression is a posterior cleft. Submucous clefting is well described, and the reason for it is also postulated. However, a congenital hard palate fistula, with a normally developed posterior palate (with its full complement of mesodermal element), is extremely rare and difficult to explain embryologically. We document a case of this nature and review various embryological theories in an attempt to explain this occurrence.