Bilateral Superiorly Based Full-Thickness Nasolabial Island Flaps for Closure of Residual Anterior Palatal Fistulas in an Unoperated Elderly Patient

Microvascular tissue transfer in cleft palate patients: advocacy of the prelaminated radial free forearm flap

The closure of wide palatal clefts and recurrent oronasal fistulae may be challenging. After repeated failure of conventional techniques, microvascular tissue transfer may be indicated in the closure of such fistulae. Depending on the location and the size of the palatal fistula, different tissues are required to sufficiently close the palatal gaps. A subdivision of common flaps into mucosa, muscular, bony, skin, and fascia flaps was carried out to analyze their suitability for alveolar, hard, and soft palate reconstruction. Furthermore, the bulk of flaps and the length of the vascular pedicle were analyzed to rate the suitability of different flaps for palatal closure. Based on a new classification of oronasal fistulae, all these factors were taken into consideration to introduce a decision guidance of what microvascular flap fits a particular clinical situation. The radial free forearm flap was found to be sufficient in the closure of all classes of oronasal fistulae.

[Oronasal fistula in sequels of labialalveolarvelopalatine clefts]

Labial and palatine maxillary clefts are treated by surgery, as for oronasal fistula. One of the most important parts of management is the timing of primary surgery in order to avoid growth disturbance. The authors describe the various possibilities to close secondary oronasal fistula. The timing and choice of surgical techniques are still debated and being improved. Various surgical techniques are available, from mucoperiosteal palatal flap to a free flap. Nevertheless, the mucoperiosteal palatal flap is the most commonly used. In some cases mucoperiosteal flaps are impossible to perform, so other options for extreme cases are discussed.