Results of difficult large palatal fistula repair by tongue flap. Management and timing of cleft palate fistula repair. Palatal fistula repair using acellular dermal matrix. Similarly, another series noted an overall fistula rate of 2. The purpose of this study was to describe the use of a palatal protective stent pps to preserve the vpi repair surgical site and to study its. Oronasal fistula repair robert b furman an oronasal fistula onf is defined as a communication between the oral and nasal cavities and occurs as a result of a defect in the gingival or palatal tissues and maxillary or incisive bone rostral to the third premolar. Original article a retrospective analysis of incidence and. The occurrence of palatal fistulae in children with a cleft palate deformity after primary palatoplasty remains a relatively. Because the local tissue was inadequate for fistula closure, a. One of the potential complications of surgery for velopharyngeal insufficiency vpi is postoperative oralnasal fistula onf. Tongue flaps for the treatment of large symptomatic. Finally, the success rate of anterior fistula repair has been dramatically improved by the addition of free periosteal grafts and cancellous bone grafts. Acellular dermal matrix in palatoplasty aesthetic surgery.
A rectovaginal fistula is an abnormal opening or connection between the rectum and vagina. The use of buccal fat pad free graft in closure of soft. May 26, 20 even in the best of hands a fistula may develop in the hard palate following operative repair. The main symptoms associated with onf are nasal regurgitation of food matter and hypernasality of voice. Construct better billing of cleft lip and palate repairs. Closure of palatal fistulae operative techniques in otolaryngology. Title assessment of palatal fistula repair using a conchal. The aim of this study is to analyze the utility of tongue flap in recurrent and large palatal fistula repair. Management of fistulae can be very tricky and a definitive success cannot be guaranteed even in the best of hands.
The purpose of this study was to examine the rate of fistula closure using conventional surgical techniques group 1 versus a newer technique group 2 employing the use of acellular dermal matrix alloderm. Descriptive study of management of palatal fistula in one hundred. Repair of cleft palate under tension is considered to be the main reason of onf though vascular accidents and infection can also be the cause. They do not assess the difficulty level of the fistula. One month prior to surgery, a plaster model of the palate was made adding a 5 to 8mmthick layer of dental putty to the level of the dental arch.
The guidelines of management of the palatal fistula is dependent on the type of cleft, site of fistula, condition of surrounding tissue and associated problem. In 12 cases, nasal lining could be reconstituted using local mucoperiosteal tissue, while in 2 cases, adjacent buccal mucosa had to be used. Pdf repair of anterior palatal fistula by local mucoperiosteal flap. Of 194 cleft palate fistula, 37 had palate repair in our hospital and 157 were refereed with fistula following palate repair. Reconstruction of anterior palatal fistula with anterior. The margins of the dehiscence or fistula should be excised and the palatal scar extended anteriorly and posteriorly of the fistula, as needed, to allow for better visualization and mobilization of the nasal lining and muscles and a tension free, layered closure. A retrospective cohort study by smyth and wu found that of 271 nonsyndromic infants who underwent a cleft palate repair involving levator veli palatini muscle repositioning with or without lateral palatal release, fistulae occurred. Palatal fistula repair methods and results 25 sex and age at the operation of these patients are shown in fig. Management of fistulae can be very tricky and a definitive success cannot be. Nasoseptal flap reconstruction of secondary palatal defects. Palatal fistula repairmethods and results 31 a tongue flap is a useful method to close a large fistula5. Palatal fistula is a failure of healing or breakdown in the primary surgical repair of a cleft palate. May 06, 2014 palatal fistula closure treatment in richardsons dental and craniofacial hospital, nagercoil, tamilnadu, india.
As nationally renowned experts in minimally invasive colorectal surgery, this means using special techniques and making the smallest incision possible the most common fistula repair procedure is fistulotomy surgery. The most common location ofthe palatal fistula is the an. The author has very limited experience with tongue flaps and has never performed free tissue transfer for palatal fistula closure. This study was conducted on 14 cases diagnosed to have fistula of the hard palate after repair of their clefts. Palatal obturators, staged procedures such as a tongue flap, or free tissue transfer are the only viable treatment options for such cases. Oronasal fistula onf is the commonest complication associated with cleft palate surgery. Typically the first step in treating a fistula is an examination by a doctor to determine the extent and path that the fistula takes through the tissue. We present the descriptive hospitalbased study of management of palatal fistula in 194 cleft patients. Palatal fistula formation is a known complication of palatoplasty. The series include study report of forty patients with secondary anterior palatal fistula post cleft palate repair, reported in a. Challenges to achieving low palatal fistula rates following. Numerous techniques for oronasal fistula repair have been described, including tongue flaps,1014 mastoid fascia grafts, 15 auricular cartilage transplantation,16 bone grafts,17 distraction osteogenesis,18 and free flap transfer.
The aim of this study was to evaluate the efficacy of closure of hard palatal fistula using two layers of oral mucoperiosteum that is elevated in a vy manner like in cleft palate repair. We describe the results of using a free cartilage graft in the closure of cleft palate fistulae in 14 patients with a mean followup of 8. Use of cartilage grafts for closure of cleft palate fistulae journal of. In one case of recurrent fistula where half the hard palate was destroyed, we closed it with a combination of intraoral flaps. Stool and gas from inside the bowel can pass through the fistula into the vagina. The twoflap palatoplasty technique was used to provide tension free, multilayer repairs. Its incidence ranges between 12 and 45 % as reported by schultz. Orthodontic movement of maxillary segments was seen to contribute to late postoperative fistula formation. Severe periodontal disease is the most common cause of acquired. In the second group, a piece of dermal matrix was interposed between the nasal and oral mucoperiosteum after closure of these layers.
The global problem of obstetric fistula obstetric fistula is the most devastating and seri frightful affliction of humankind. Palatal obturators can be obtained prefabricated and trimmed to fit the patient or can be custom made chairside with composite or acrylic figure 6. Dentistry journal free fulltext palatal protective. A 2yearold boy presented with a large palatal fistula measuring 4, 5 cm. Combined tongue and pharyngeal flaps for reconstruction of. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation.
Palatal fistulas represent a challenging problem for surgeons caring for patients with cleft palate. The purpose of this study was to examine the palatal fistula rate after repair with the twoflap palatoplasty technique. Palatal fistula results in persistent communication between oral and nasal cavities leading to unpleasant symptoms such as nasal spillage of feeds, hypernasal speech, articulation problems which undermine the success of palate repair. We have successfully closed palatal defects by temporalis muscle but not in a cleft patient. Sixth, the best treatment for palate fistula is prevention using dissection techniques.
In this study a tension free repair of the anterior. Fistula as a result of dehiscence of the initial cleft palate repair can be difficult problem. A fistula is an abnormal connection between two hollow spaces technically, two epithelialized surfaces, such as blood vessels, intestines, or other hollow organs. As for the cleft type, bclp bilateral cleft lip and palate was most frequent. In 1 case, a single layer closure with a tongue flap was successful. The integrity of the palatal mucosa can be lost due to congenital, pathological, and iatrogenic conditions. Risk of persistent palatal fistula in patients with cleft.
The incidences of palatal fistulas in patients with clefts of the hard and soft cleft palate 744, 21%, and bilateral cleft lip or palate 221,10%, were significantly higher than those in. Fang s 2018 reconstruction of large anterior palatal fistulae using anteriorlybased dorsal tongue flaps otorhinolaryngol head ec surg, 2018 doi. Repair of large palatal fistula using tongue flap nawfal f. The flap is a good option for fistula repair, especially for larger fistulae at the anterior portion of the hard palate or at the junction of hard and soft palate, where surrounding soft tissues. The surgical techniques in group 1 varied and were considered a historical control.
Palatal fistula closure treatment in richardsons dental and craniofacial hospital, nagercoil, tamilnadu, india. A selection of 22 cleft palate children undergoing tertiary palatal fistula repair n 16 or closure of a complex wide primary palatal defect n 6. Although a buccal musculomucosal flap bmmf is effective for fistula repair, it does have the following problems. The main causes are poor surgical technique or vascular accidents and infection. Posteriorly based buccinator myomucosal flap is a good choice in such. Correction of postpalatoplasty hard palatal fistula the annals of. Robert b furman in most cases, the single layer mucogingival flap. Recurrent palatal fistulas following primary cleft palate repair are uncommon, with an incidence ranging between 9% and 34%. This aspect receives care full attention our clinic. In that study, a yearold patient with leukemia underwent the successful closure of a large palatal fistula using a tongue flap 6.
His fistula was secondary to a hard palate necrosis after primary closure procedure. Many creative methods of fistula repair have been reported. Fistula is preventable women experiencing obstructed labor. Recurrent palatal fistula is a common complication of cleft palate repair. Custommade palatal shield use in cleft palate and fistula. Reconstruction of large anterior palatal fistulae using. Numerous classifications have been proposed that help in identifying the location of fistula and systematically arrange data for record keeping. Closure of palatal fistula with buccal fat pad request pdf. Several options for fistula repair have been described including tongue flaps 2, buccal myomucosal flap 3, pedicled flaps 4, free flaps 5, and free cartilage grafts 6 with varying success. The aim of the current study is to present the free buccal fat pad graft as a novel technique to repair the softtissue defects at the palate. Vy twolayer repair for oronasal fistula of hard palate. All the patients had undergone repair of cleft palate and fistula previously. Veauwardill kliner technique was used to repair 4 3. Revisions typically are necessary due to poor healing, dehiscence, or scar contracture from the.
Your surgeon will draw from a variety of techniques to access and repair your fistula. Despite the multitude of techniques, there is no procedure that reliably yields promising results and consistent rates of recurrence. This can lead to leaking of stool or gas through the vagina. Thirtysix cleft surgeons responded to the online survey study. Keywordsoroantral fistulaoaf, palatal flap, caldwell luc. The closure of a residual postpalatoplasty anterior palatal fistula can be. The easy mobilization of the palatal flap, its excellent blood supply, and minimal donor site morbidity make it an ideal flap in such cases. Of these, 45% used adm in primary cleft palate repair, while 67% used adm for repair of oronasal fistulae. Treatment modalities for surgical management of anterior. Closure of huge palatal fistula in an adult patient with iso. Numerous classification systems have been put forth over many years. Therefore, orthodontic movement should be completed before undertaking surgical repair of anterior palatal fistulas. Use of regenerative tissue matrix as an oral layer for the.
Because the local tissue was inadequate for fistula closure, a tongue flap was indicated. Aim of this retrospective study was to access the various surgical treatment options available for repair of anterior palatal fistula depending upon their size and presenting age, and also to anticipate the treatment outcome. Cohen patients born with cleft lip andor palate require the care of several specialists and a number of surgical procedures and other interventions, from infancy to adulthood, to achieve total habilitation and have the opportunity to live normal and productive lives. Conventional methods of surgical repair of hard palate fistulas were seen to result in a very poor success rate. Easy closure of anterior palatal fistula with local flaps.
Tongue flap as salvage procedure for recurrent and large. We studied the management and outcome of 194 cleft palate fistula in our institute. Anteriorly based tongue flaps were used to close 15 palatal fistulae, a majority of which had followed earlier surgery for cleft palate closure. Various surgical techniques have been suggested for the closure of palatal defects. If the patient develops a deformity requiring a revision of the previous repair, report 40720 plastic repair of cleft lipnasal deformity. Repair of primary cleft palate and oronasal fistula with. Palatal fistula is a significant complication following cleft palate repair. Palatal fistula was defined as a breakdown of the primary surgical repair of the palate, resulting in persistent patency between the oral and nasal cavities. The tongue flap has abundant blood supply to cover the oral surface even if the lining flap is poor. Several factors are on account of these disproportionate rates. A fistula of sufficient size can lead to significant problems, ranging from oral fluid and food regurgitation into the nasal chamber. The difficulty in repair comes from unavailability of surrounding healthy tissue for adequate tension free closure. Free flaps such as radial forearm flap are also indicated for large palatal closure. Their respective indications are discussed in terms of the.
Objectiveto investigate the predictive associations of persistent palatal. Fistulas are generally a disease condition, but they may be surgically created for therapeutic reasons. To see the outcome of closure of anterior palatal fistula by local. A repair technique which used local flap and free tissue transfer has been tried but the outcomes have not been satisfying. From january 2008 to july 2016, 18 patients with recurrent palatal fistula were included in the study. United states more than 100 years ago thanks to emergency cesarean section surgery. Pdf buccinator flap as a method for palatal fistula and. The pooled estimate for recurrence of fistula after attempted repair using adm was 11%.
Defect anatomy, location and size are important factors in order to decide upon treatment and to determine the type of. Correction of palatal fistula was planned in 43 35. A large congenital defect of the caudal hard palate was present in a young golden retriever a. Thirtyseven patients of the palatal fistula after primary palatoplasty were. May 26, 20 palatal fistula formation is a known complication of palatoplasty. In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator to delay the need for surgery to a more appropriate age. Jun 11, 2019 a retrospective cohort study by smyth and wu found that of 271 nonsyndromic infants who underwent a cleft palate repair involving levator veli palatini muscle repositioning with or without lateral palatal release, fistulae occurred in 28 patients 10.