Oronasal Fistula Research Articles

A Straightforward Technique to Repair a Residual Oronasal Fistula in Bilateral Cleft Lip and Palate Patients

An anterior palatal oronasal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The purpose of this article is to present a 2-stage technique to repair the fistula in consistent fashion. The technique was developed to avoid more complicated procedures that had greater morbidity for larger oronasal defects that could not be treated in a single procedure. This is a retrospective study performed over 15years using this technique in a private practice setting. From 2002 to 2017, 15 7- to 12-year-old patients (11 boys and 4 girls) were treated. They were seen in a multispecialty clinic for anterior residual fistulae, and impressions were obtained. Then, they were scheduled for first-stage closing of the fistulae. Data were retrospectively analyzed. The first stage started with closing the central portion of the fistulae. For the second stage 6months later, the residual nasoalveolar cleft was closed and grafted in standard fashion. The first stage involved posteriorly reflecting a full-thickness mucoperiosteal flap and inserting it into the palatal soft tissue and stabilizing the segment with a splint for 3weeks. The premaxillary segment was left denuded. Fourteen of 15 patients (93%) had the central portion of the oronasal fistulae successfully closed. One patient had partial breakdown when the splint was prematurely removed at 2weeks. The patient underwent successful closure by the same procedure at a later date. All patients had successful second-stage grafting of their nasoalveolar clefts. An alternative technique is presented to treat clinically challenging oronasal fistulae. This 2-stage closure of a palatal fistula is straightforward, allows consistent closure of soft tissue defects, and avoids complex alternative procedures with serious surgical morbidities.

Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database.

Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes. Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery. Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63). Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate. Risk, III.

The incidence of velopharyngeal insufficiency and oronasal fistula after primary palatal surgery with Sommerlad intravelar veloplasty: A retrospective study in Isfahan Cleft Care Team

ObjectivesThis study was designed to determine the incidence of velopharyngeal insufficiency (VPI), oronasal fistula development and facial grimace in patients seen by Isfahan Cleft Care Team (ICCT) after primary Sommerlad intravelar veloplasty (SIVV). Furthermore the association of gender, cleft type and age at primary surgery with the incidence of hypernasality and fistula is determined. MethodsA group of 40 patients with history of cleft palate with or without cleft lip were identified from the records of ICCT between 2011 and 2014. The main outcome measures were the incidence of hypernasality and fistula after primary palate repair with SIVV. Speech recordings were analyzed by consensus by two speech therapists according to the Cleft Audit Protocol for Speech- Augmented (CAPS-A), (Kappa = 82.4). Deciding whether or not to have a fistula was based on the oral examination videos. ResultsSevere and moderate hypernasality was observed in 42.5% of patients. Normal resonance and mild/borderline hypernasality was observed in 37.5% and 20% of patients, respectively. The frequency of fistulas was 7.5%. There was a significant association between hypernasality with cleft type and the age at primary surgery (p < 0.05). ConclusionSignificant progress has been made in the outcomes of the primary palate surgeries with the SIVV technique compared to the previous study in the ICCT.

Rosselli-Gulienetti Syndrome: Clinical Presentation and Management – A Rare Case Report

Rosselli-Gulienetti Syndrome (RGS) is an inherited genetic disease, follows an autosomal recessive pattern of inheritance. This is a case of completely edentulous RGS with incomplete closure of the roof of the mouth and a cleft lip with an Oronasal communication. The presence of an Oronasal fistula presents a challenge to Maxillary complete denture fabrication because leakage of air from the nasal cavity through the fistula prevents the formation of an adequate border seal and further absence of anterior portion of alveolar ridge and lip, worsen the retention of the denture. The overall goal of rehabilitating such patients is focussed on closure of Oronasal communication, improving acceptable speech, appearance, proper occlusion and masticatory function. This clinical report illustrates an alternative solution by integrating a small retentive component into a Maxillary complete denture.

Prevention of oronasal fistula in primary palatoplasty with acellular dermal matrix

Palatal fistula after primary palatoplasty remains one of the most difficult complications that plastic surgeons have to face. Once the fistula has developed, the complexity of the reconstruction increases significantly, and the revisional surgery results are not promising. The recent use of acellular dermal matrix (ADM) provides a new perspective for the reconstructive surgeon. Our goal is to reduce and prevent the postoperative oronasal fistula in patients with cleft palate by placing an ADM in the zone 3 and 4 of Pittsburgh (hard palate and hard–soft palate junction), creating an extra layer for support of the cleft palate. Seven children diagnosed of palatal cleft with high risk of developing oronasal fistula were operated. The technique of choice was two-flap palatoplasty with lateral incisions and intravelar veloplasty and three-layered closure with ADM in the hard palate and hard–soft palate junction. One patient developed a 3-mm oronasal fistula at 3-month follow-up, with spontaneous closure at 12 months. The rest of the children had an uneventful evolution. Our rate of postoperative oronasal fistula was 0% at 12 months. The use of ADM in primary palatoplasty had been of great use to prevent complications in high-risk oronasal fistula patients.

Closure of oronasal fistula by palatal rotational flap: case report with two years follow-up

Background/Aim: Hard palate fistulas are due to pathologies such as noma, syphilitic gom, leprosy, leishmaniasis, radiotherapy, removal of cysts or tumors of the sinus or palate, trauma or tooth attraction. Symptoms of palatal fistulas include hypernasality in the phonation due to nasal air escape during a speech, nasal cavity fluid flow, and infection due to food accumulation. Surgical repair of palatal perforations is technically difficult and complicated. Different surgical methods can be used depending on the size and location of the defect. Among these techniques, the locoregional flap types used are palatal flap, nasolabial flap, a buccal fat pad and tongue flap. Case Report: In this case report, we presented a patient with oronasal fistula due to a previous surgical operation, which was surgically closed by a palatal rotational flap. Conclusions: As a result, the oronasal communucation was relieved by successful closure of the defect and the donor area healed uneventfully.

Language Proficiency in Children with Cleft Palate

Children with cleft palate (CCP) are at risk for a wide range of speech disorders that commonly includes hypernasality, nasal emission and/or articulation errors such as compensatory articulation (CA). Hypernasality is the excessive nasal resonance and can be noted during the production of consonants and even vowels; nasal emission is escape of air through the nose related to velopharyngeal insufficiency (VPI). Other cause for nasal emission can be an oronasal fistula that allows communication between the nasal and oral cavities. As these speech disorders are caused by an anatomical deficiency treatment has to be physical manipulation and cannot be treated in speech therapy [1]. In contrast, articulation errors should be treated in speech therapy.

Microstructured beta-tricalcium phosphate for alveolar cleft repair: a two-centre study

The current standard of care in alveolar cleft repair is timing the procedure in the mixed dentition stage and making use of autologous bone to restore the maxillary defect. Using a synthetic bone substitute bypasses the risk of donor site morbidity and reduces the operation time. In this study, the outcome of alveolar cleft repair using microporous beta-tricalcium phosphate (β-TCP) was investigated in patients with unilateral cleft lip and palate. Twenty patients were enrolled prospectively in this study, divided between two centres. Continuity of the alveolar process, recurrence of oronasal fistulas, and eruption of teeth into the repaired cleft were evaluated at 1year postoperative. Also, cone beam computed tomography scans were analyzed using a volume-based semi-automatic segmentation protocol. No adverse events were reported. The mean residual bone volume in the repaired cleft at 1year postoperative was 65%. There was no recurrence of oronasal fistula. Furthermore, 90% of the teeth adjacent to the cleft erupted spontaneously and all patients showed a continuous alveolar process. Secondary alveolar grafting using microporous β-TCP can safely be used in the clinical situation. Residual calcified tissue, canine eruption, and complication rates at the recipient site are comparable to those with autologous grafts.

Surgical outcome of two-flap palatoplasty at King Fahad Medical City: A tertiary care center experience.

The purpose of this study was to assess surgical outcomes of two-flap palatoplasty for management of cleft palate.Between January 2009 and January 2017, we recruited 29 nonsyndromic patients who underwent two-flap palatoplasty for cleft palate repair at the oral and maxillofacial department. Their medical records were procured, and surgical outcomes were assessed. Velopharyngeal insufficiency (VPI) was evaluated on the basis of speech assessment by a speech therapist. Speech abnormality (nasality, nasal emission, and articulation error) was assessed by a speech therapist using the GOSS-Pass test. Swallowing and regurgitation were assessed by a swallowing team. Fistula and wound dehiscence were clinically assessed by the primary investigator. Documented data were evaluated using statistical analysis. Among the study patients; 75.8 % had normal speech, 20.7 % developed VPI; 17.3% had hypernasality; 4.3% had hypernasality as well as nasal emission; 4.3% had hypernasality, nasal emission, and articulation errors; and 4.3% had articulation errors. Approximately 20% of the patients had fistulas (83.3% had oronasal fistulas and 16.7% had nasovestibular fistulas). Normal swallowing findings were noted in 93% of the patients. There were statistically significant relationships between age-repair and VPI (r=0.450, t=0.014), age-speech (r=0.525, t=0.003), and age-fistula development (r=0.414, t=0.026). Conversely, there were no significant relationships between age and dehiscence (r=0.127, t=0.512), age and swallowing (r=0.360, t=0.055), and age and regurgitation (r=0.306, t=0.106). Two-flap palatoplasty is a reliable technique with excellent surgical and speech outcomes. Early repair is associated with better speech outcome and less incidence of VPI.

Extraction of the maxillary canine tooth in dogs

The maxillary canine tooth is a large tooth that often leaves a large defect when extracted. An open extraction is therefore usually the most appropriate technique. This technique will also allow suitable closure of the extraction site, to minimise the risk of the development of an oronasal fistula following tooth extraction.

Outcomes of surgical repair of congenital palatal defects in dogs.

OBJECTIVE To determine and identify variables associated with outcomes of surgical repair of congenital palatal defects in dogs. DESIGN Retrospective case series with nested observational study. ANIMALS 26 dogs that underwent surgical repair of congenital palatal defects at 2 veterinary teaching hospitals from 2007 to 2016. PROCEDURES Data were collected from medical records regarding dog age and body weight at the time of surgical defect repair, prior surgical history, skull type (brachycephalic, mesocephalic, or dolichocephalic), surgical technique used for defect repair, and defect severity. Functional outcome as well as frequency and location of oronasal fistula (ONF) formation were recorded. These outcomes were compared among various groups. RESULTS Surgical defect repair achieved functional success in 22 of the 26 (85%) dogs. An ONF formed after initial repair in 13 (50%) dogs, and the most common location was the hard palate. Hard palate ONF formation was more common in dogs > 8 months of age at the time of initial repair; ONF at the junction between the hard and soft palates was more common in dogs > 8 months of age at the time of initial repair and in dogs with a history of failed surgical repair. An unsuccessful functional outcome was more common in dogs weighing < 1 kg (2.2 lb) at the time of initial repair. CONCLUSIONS AND CLINICAL RELEVANCE Patient age, patient size, and defect characteristics should be taken into consideration when planning and assessing prognoses for surgical repair of congenital palatal defects in dogs.

Interventional treatment of benign nasopharyngeal stenosis and imperforate nasopharynx in dogs and cats: 46 cases (2005-2013).

OBJECTIVE To determine outcome for dogs and cats with benign nasopharyngeal stenosis or an imperforate nasopharynx that underwent balloon dilatation or metallic stent placement. DESIGN Retrospective case series. ANIMALS 15 dogs and 31 cats. PROCEDURES Medical records were retrospectively reviewed, and data on signalment, history, clinical signs, lesion location, treatment, and outcome were obtained. Patients were excluded if < 6 months of follow-up information was available. RESULTS 5 dogs and 22 cats underwent balloon dilatation, and results were successful in 11 (0 dogs and 11 cats) of the 27 (41%). Stents were placed in 34 patients (including 15 in which balloon dilatation had been unsuccessful). Uncovered stents were placed in 30 patients, and results were successful in 20 (67%). Covered stents were placed in 11 patients (including 7 in which uncovered stent placement was unsuccessful), and results were successful in all 11. Twenty-three of the 34 (68%) patients in which stents were placed developed complications. The most common complications were tissue ingrowth (n = 10), chronic infection (7), and stent fracture (5) for the 30 patients with uncovered stents and chronic infection (8) and oronasal fistula (3) for the 11 patients with covered stents. Overall, outcome was successful in 36 of the 46 (78%) patients (median follow-up time, 24 months; range, 2 to 109 months). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in dogs and cats, nasopharyngeal stenosis and imperforate nasopharynx can be successfully treated with balloon dilatation or stent placement, but that there was a high risk of failure with balloon dilatation alone and a high risk of complications regardless of procedure.

The Impact of Presurgical Infant Orthopedics on Oronasal Fistula Rates Following Cleft Repair: A Meta-Analysis.

Presurgical infant orthopedics (PSIO) techniques were introduced to improve the outcomes achieved when treating children with complete cleft lip and palate. The effect of PSIO on the incidence of postoperative fistulae has never been reliably demonstrated. We conducted a meta-analysis to assess the effectiveness of PSIO in reducing postoperative fistulas in patients with complete cleft lip and palate. A search of the PubMed and Embase databases was performed to identify relevant articles that included primary palate repairs of patients with unilateral or bilateral complete clefts, reported the incidence of postoperative fistulae, and explicitly stated if PSIO was used. Details including author, number of subjects, use of PSIO, and fistula rate were cataloged. A review of the PubMed database yielded 1135 unique citations, and Embase yielded 507 articles. Review of these yielded 15 studies, comprising 1241 children, which met inclusion criteria. The overall rate of oronasal fistula development was 7.09%. The average fistula rate for studies using PSIO was 5.93% versus 9.71% in the non-PSIO group. This difference was not statistically significant ( P = .34). The use of PSIO prior to cleft lip and palate repair provides multiple benefits related to facial and nasal form and is supported by a body of literature. The effect of PSIO on the incidence of postoperative fistulae has received less attention in the literature. Our meta-analysis of the available literature does not provide evidence to support the premise that the use of PSIO affects the incidence of fistulae after cleft palate repair.

Evaluation of use of platelet rich fibrin combined with autogenous iliac bone graft for closure of unilateral alveolar cleft

Purpose: The aim of this study was to evaluate the use of platelet rich fibrin combined withautogenous iliac bone graft for closure of unilateral alveolar cleft.Patients and Methods: Eight patients with unilateral alveolar cleft were included in this study,5 patients were males and 3 patients were females, their ages ranged from 9-11 years with a meanof 8.9 years. All patients were evaluated preoperatively both clinically and radiographically. Allclinical and radiographic parameters were performed immediate, 1, 3and 6 months postoperatively.Results: All patients showed uneventful wound healing, without any evidence of occurence ofwound infection except in case no. (7), who showed presence of infection after one month but thecase was improved through the late follow-up with administration of I.V. antibiotics. Regardingto extrusion of iliac crest graft, no graft extrusion occurred through all the follow-up periods. Thevisual analogue pain scale (VAS) revealed no pain after 6 months follow-up periods in all patients.All patients showed uneventful closure of the alveolar arch and no oronasal fistula had been detectedin any patients through all the follow-up periods. Radiographic evaluation revealed proper heightand density of the inserted iliac crest graft.Conclusion: The use of combined mixture of platelet rich fibrin (PRF) and autogenous chips ofiliac crest graft is safe and efficient method for performing repair to the alveolar cleft as this mixtureleads to occurence of proper increase in bone height and density of the repaired alveolar cleft.

Two Methods of Cleft Palate Repair in Patients With Complete Unilateral Cleft Lip and Palate

The objective of this study was to compare the surgical outcome between 2 patient groups with complete unilateral cleft lip and palate who underwent different types of palatoplasty. This is a cohort study between 2 groups of patients with complete unilateral cleft lip and palate who were operated using different surgical techniques from 2008 to 2011. About 28 patients were operated using a primary lip nose repair with vomer flap for hard palate single-layer closure and delayed soft palate repair (modified Oslo protocol) and 32 patients were operated using our protocol in Lima. Data collection was accomplished by evaluation of symptomatic oronasal fistulas, presence of velopharyngeal insufficiency and evaluation of dental arch relationships (scored using the 5-year-olds' index). Our comparative study observed statistically significant differences between the 2 groups regarding the presence of oronasal fistulas and velopharyngeal insufficiency in favor of our palatoplasty technique. A statistically significant difference was not found in functional vestibular oronasal fistula development between the studied techniques for unilateral cleft palate repair. This comparative study did not observe significant differences in dental arch relationships between the studied techniques. In this study, better surgical outcome than modified Oslo protocol regarding oronasal fistulas and velopharyngeal insufficiency on patients with complete unilateral cleft lip and palate was observed. The results arising from this study do not provide evidence that one technique is enough to obtain better functional closure of the alveolar cleft and dental arch relationship at 5 years.

Computed tomographic features of equine oromaxillary sinus and oronasal fistulae

Computed tomographic features of equine oromaxillary sinus and oronasal fistulae

Unilateral Cleft Lip and Palate Surgical Protocols and Facial Growth Outcomes.

Adequate dentofacial growth is an objective of unilateral cleft lip and palate treatment. No study exists, comparing the dental arch of 5-year-old relationship after 2 treatment protocols: one with single-stage palatoplasty and another with delayed hard palate closure (DHPC). The authors hypothesized that the DHPC protocol provides better dentofacial growth. A single-center, single-surgeon Randomized Clinical Trial was performed to evaluate the maxillomandibular relationships in 2 groups. The intervention group (GI) underwent palatoplasty with DHPC between ages 3 and 4 years; the control group (CG) underwent complete palatoplasty between 9 and 15 months. The authors evaluated oronasal fistulae rates.The dental arch relationship was evaluated via blinded panels using the Five Year Old Index.Kappa statistics were calculated to assess reliability. Trials were statistically tested with the t test and chi-squared test. Sixty-four patients constituted the study sample. The incidence of oronasal fistulae was 9.4% (GI) and 6.7% (CG). Sixty-two models with an average age of 55 months were available for analysis. Good intra- and inter-rater reliabilities (0.73-0.93 and 0.60-0.94, respectively) were obtained. Average index scores ranging from 2.04 (GI) to 2.76 (CG) were significantly different (P = 0.007). Significant between-group differences (P = 0.006) were found in scores, 1 and 2 in the GI (74%) and CG (52%). When the distributions were compared by the median, a difference was found (P = 0.024) in score, 1 between the GI (31.2%) and CG (3.3%). Although the DHPC protocol yielded better outcomes relating to dentofacial growth, other protocols should be investigated and findings verified by other researchers.

Bilateral Cleft Lip and Palate, With Facial Dysplasia: Interdisciplinary Treatment and Long-Term Follow-Up.

Bilateral complete clefts represent the result of an incomplete fusion with all the morphologic components present. It is well known that patients with bilateral cleft lip and palate have typical characteristics such as insufficient medial face development with an orthodontic class III tendency, flat nose and short columella with abnormal nasolabial angle, bilateral oronasal fistulas, alterations in the number and position of the lateral incisors, and agenesis or supernumerary teeth. Successfully solving these cases, results in a difficult challenge and studies showing extended follow-up are not frequent. Bilateral complete clefts, including medial facial dysplasia, are a rare condition, not only difficult to be included in any classification but also of complex solution. These patients require multiple surgical procedures throughout life, and long-term results are often still far from ideal. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome. However, if the ideal timing and type of surgery are known, in combination with the intrinsic growth potential, these results could be ameliorated. A patient with complete bilateral cleft, presenting hypoplasia of philtrum and premaxilla, flat nose with rudimentary columella and septum, is reported. A description of her interdisciplinary treatment and long-term outcome with an adequate and stable result was observed. Being the intrinsic growth restriction mainly localized in the central mid-face, a protocol oriented to stimulate facial development during growth period could be essential to reduce the number of surgical procedures and prevent sequels. Early referral to a specialized center is mandatory to achieve a correct treatment and result.

Abstract: Prophylactic Use of Buccal Fat Flaps to Improve Oral Mucosal Healing Following Furlow Palatoplasty

BACKGROUND: Furlow palatoplasty (FP) is increasingly used both for primary palatoplasty and secondary correction of VPI. While FP offers the advantage of lengthening the palate, the most tenuous component of the oral mucosal repair is anterior transposition of the oral mucosal z-plasty flap. When a secondary FP was done to correct VPI following primary FP, the senior author found oral mucosal separation in 53% of cases. To mitigate this problem, we prophylactically placed pedicled buccal fat pad flaps to provide an additional vascular layer to promote healing of the overlying oral mucosal z-plasty flap. METHODS: A retrospective chart review identified patients who underwent pedicled buccal fat pad flaps with FP performed by the senior author (A.G.). Cleft palate diagnosis, Veau classification, primary and secondary palate repair surgeries, surgical technique and post-operative complications were extracted. The need for buccal fat flap augmentation was determined if the oral mucosal z-plasty flap showed duskiness during transposition or was under tension at the time of closure. Unilateral versus bilateral buccal fat flaps were chosen based on expected areas of tension in the final repair. On the buccal mucosa, a longitudinal incision just lateral to the most posterior aspect of the alveolar ridge was made, from which buccal fat was gently teased out. This was tunneled submucosally to the palatal repair site, where it was secured just posterior to the hard palate and anterior to the transposed levator veli palatine muscle. The oral side of the Furlow palatoplasty was then brought together over these pedicled buccal fat flaps. RESULTS: We identified six patients who underwent FP with buccal fat flap augmentation. Two patients (33%) were primary FP while four patients (67%) were secondary FP. Three patients had unilateral cleft lip and palate, two had submucosal cleft palate and one had cleft palate only. The youngest patient was 11 months old, and the oldest was 7 years and 9 months. Half of the procedures used bilateral buccal fat pad flaps while the remainder were unilateral. All patients were seen at two weeks postoperatively and followed up regularly, with average follow-up time of 21 months (range 8–41 months). Post-operatively, one patient demonstrated a 1 cm area of mucosal dehiscence at the tip of the posterior triangular flap, which healed uneventfully. There were no other post-operative complications observed, including donor-site complications, complications relating to the buccal fat pad flap. No patient developed an oronasal fistula. DISCUSSION: Our experience suggests that the buccal fat pad flap may minimize vascular compromise and dehiscence of the oral mucosal z-plasty following FP. This separation rate decreased from 8/15 (53%) patients in our prior series of secondary FP procedures to 1/4 (25%) patients undergoing secondary FP with buccal fat flaps. Cleft palate surgeons should consider adding this low-risk technique to their repertoire, as it provides an additional vascular layer beneath the most tenuous part of the oral mucosal closure in a FP, and may improve vascularity to the overlying oral mucosa so as to minimize dehiscence at this closure.

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

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.