Background
Palatal defects are commonly encountered complication with cleft palate surgery. The anatomical location of the fistula can vary significantly but commonly occurs in the hard palate or at the junction with soft palate. Treatment is tailored according to site, size, and clinical presentation. A wide range of surgical options have been tried. This study aimed to discuss the outcome of proposed bilayered reconstruction with medially based pedicled orbicularis oris myomucosal flap.
Patients and methods
A total of 16 consecutive patients were presented with isolated secondary anterior oronasal fistula of ∼6.6±2 mm size, classified as Pittsburgh type V − primary palate at incisive foramen or junction of primary and secondary palate. Overall, 11 (68%) were bilateral and treated for primary closure by Von Langenbeck technique, whereas five patients were unilateral incomplete and were also have the same primary treatment at an average age of 24 months. Surgical reconstruction aimed to achieve bilayered closure of the defect using hinged mucoperiosteal flaps and myomucosal orbicularis oris flap.
Results
Of 16 patients, 15 (93.7%) had the oronasal fistulae, uneventfully, healed within 2–3 weeks. One patient had partial breakdown without gapping of the nasal layer. The average operative time was 60 min. This flap can reach as far as 3–4 cm into the palate. Follow-up to 12 months has been completed with no evidence of recurrence. Preoperative symptoms of nasal regurgitation and hypernasality had significantly improved.
Conclusion
Medially based pedicled orbicularis oris myomucosal flap used in a bilayered pattern is a safe and reliable option for closure of anterior palatal defects.