Treatment of palatal fistula using tongue flap

ABSTRACT

Primary treatment of cleft palate should result in an intact palate with separation of the oral and nasal cavities. However, the published reports of large series indicate that palatal fistula present in operated cleft palate of a small but significant groups of patients. Even in the best hands, a palatal fistula of the operated cleft palate may reoccur postoperatively. Various methods of repair including local mucosal flaps have been employed to date, but fistula repair is extremely difficult because the operative field is limited by scar formation around the palatal fistula, making wound healing unsatisfactory. In such cases, a tongue flap is commonly indicated. From May of 1991 to May of 1996, among 19 patients with palatal fistula in operated cleft palate, 11 patients were operated by anteriorly-based tongue flap. All patients were followed up for at least 6 months, with mean follow up of 18 months. Among 12 cases of 11 patients included in this study, 11 flaps survived and did not recur during follow up periods. One complication was seen in the first case. In this case, there was a flap detachment from the recipient site on the 3rd postoperative day, but he was treated successfully at a subsequent operation. There have been no problems with feeding and communication until the pedicle is cut, and no patient experienced problems either with alteration in speech or with disturbance of taste sensation following surgery. In conclusion, this study shows that the anteriorly-based tongue flap is a safe and reliable technique for closure of large palatal fistula.