ABSTRACT
Small palatal fistulas following surgery for cleft palate can be corrected easily by local mucoperiosteal flap. But fistula repair is difficult if the fistula is large in hard palate. Tongue flaps are the most commonly used flaps for closure of difficult palatal fistulas. The authors treated 38 patients of large palatal fistulas using tongue flap. Among them, 33 patients were operated using posteriorly based tongue flap, and 5 patients were operated using anteriorly based tongue flap. In the former, all flaps were successfully survived and not necessary a fixation of tongue after flap transfer. But in the latter, tongue flap of a patient was detached because of high mobility, and tongue flap of a patient was necrotized because of poor blood supply. For closure of large palatal fistula, posteriorly based tongue flap is safer and more reliable technique than anteriorly based tongue flap considering mobility and blood supply.