Background: Oro-nasal fistulae (ONF) is considered one
of the commonest sequelae of cleft palate repair. Fistulae closure
can represent a simple procedure or a great challenge.
Usually, it is not easy to close large ONF using adjacent local
tissues, which necessitates the displacement of tissues from
nearby anatomical regions.
Objective: Evaluation of a new technique for fistula closure
and palatal lengthening in ONF.
Patients and Methods: Between the period of 2017 to 2020
this prospective study was performed on seven cases with large
anterior ONF underwent surgical repair using bilateral Buccinator
Myomucosal Flaps (BMMF), one acts as a second layer
for fistula closure and the second one added more length to the
palate. Patient evaluation was based on clinical evaluation for
fistulas recurrence, speech intangibility using Intelligibility in
Context Scale (ICS) which performed preoperatively and one
year post-operatively, and improvement of nasal regurgitation.
Results: Seven non syndromic cases with large anterior
ONF were included in this study of them five females and two
males with mean age (7.57±1.90) underwent fistula closure
with our new technique. On postoperative follow-up one case
(14.3%) complicated with oral layer disruption that resolved
conservatively, also two cases (28.6%) suffered from chest
infection which required prolonged hospitalization. Improvement
of nasal regurgitation, with no fistula recurrence occur
in all seven cases. Assessment of speech intelligibility was
done using Intelligibility in Context Scale (ICS) showing that
(71.4%) were improved to score >3.5 which means that their
speech is usually to sometimes understood to others.
Conclusion: The use of our new technique is a reliable
method that may be used for large anterior ONF closure and
lengthening of short scarred palate with few drawbacks and
multiple benefits.