A simple technique to repair a residual oronasal fistula in bilateral cleft lip and palate patients

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Bruce R. Nicol, Noel Ye Naung, Joseph E. Van Sickels

Purpose

An anterior palatal oronasal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The purpose of this paper is to present a two-stage technique to repair the fistula in consistent fashion. The technique was developed to avoid more complicated procedures that had greater morbidity to be used on larger oronasal defects that could not be treated in a single procedure.

Methods

This is a retrospective study performed over fifteen years using this technique in a private practice setting. From 2002 to 2017, fifteen 7 to 12-years-old patients (11 male and 4 female) were treated. When they were seen in a multispecialty clinic with an anterior residual fistulae impression were obtained. They were then scheduled for a first stage closing of the fistulae. Data was retrospective analyzed. The two-stage procedure started with closing the central portion of the fistulae as the first stage. During a second stage 6 months later, the residual nasoalveolar cleft would be closed and grafted in a standard fashion. The first stage involves posteriorly reflecting a full thickness mucoperiosteal flap and inserting into the palatal soft tissue and stabilizing the segment with a splint for three weeks. The premaxillary segment was left denuded.

Results

Fourteen out of fifteen patients (93%) had the central portion of the oronasal fistulae successfully closed. One patient had a partial breakdown when the splint was prematurely removed in 2 weeks. The patient underwent successful closure by the same procedure at a later date. All patient had a successful second stage grafting of their nasoalveolar clefts.

Conclusion

An alternative technique was presented to treat the clinically challenging oronasal fistulae. This two-stage closure of a palatal fistula is simple, allows consistent closure of the soft tissue defects, and avoids complex alternative procedures with significant surgical morbidities.

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