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Background: Palatal Fistula according to previous studies is directly proportional to width of the clefts. The fallacies with these studies were presence of multiple confounding factors such as multiple surgeons using different techniques of repair. Aim: This study attempted to assess the correlation between the actual width of cleft (W) and ratio of cleft width to sum of width of palatal shelves (R) with the incidence of palatal fistula done by single surgeon using same standardized repair thus eliminating bias due to multiple variables. Methods: This study includes consecutive cases of palatoplasty over 18 months. Bardachs 2 flap palatoplasty with radical Muscle dissection was performed. Palatal fistula was assessed at 3 weeks and at 2months. Results were analyzed with Wilcoxon signed rank test. Results: The values of W and R were analyzed in 45 patients. At 3 weeks 4 patients had fistula (8.9%) while at 2 months follow up only one patient (2.2%) had it. In patients without a fistula (n=41), the mean W was 1.22+0.31 cms SD (range 0.4 to 1.9cm) and R was 0.47+0.14 SD (range 0.15 to 0.83). In 4 patients with fistula at 3 weeks, the mean W was 1.28+0.39 cm SD (range 0.90 tp 1.8 cm) and R was 0.60+0.37 SD (range 0.35 to 1.13). This difference was not statistically significant (P value- 1.000 and 0.968 respectively). Conclusion: This study shows correlation between the width of the cleft or the width of palatal shelves have no significant influence on palatal fistula. The high incidence in previous studies may be related to surgical techniques.

Individuals with cleft lip and palate may experience problems with feeding, speaking, hearing, and social integration that can be corrected to varying degrees. This case report presents a method of restoration of form, function, and esthetics in a 14-year-old patient of cleft palate fistula. Interim hollow obturator was added to the lightness of the prosthesis along with adding resonance of speech and preventing regurgitation of fluids. Porcelain-fused metal crowns were also added to the overall esthetics of the patient that is one of the primary concerns during adolescence.

Background: Skull base is difficult to approach surgically due to its complex anatomy. A number of procedures that is endoscopic, microscopic, and open approaches have been used. The maxillary swing approach provides a wide exposure to the surgeon for better oncological clearance. Patients and Methods: A total of 62 patients with varied etiologies involving the skull base region were operated with maxillary swing procedure over a period of 15 years from 2001 to 2016 in plastic surgery department at a single institution. Results: There was no recurrence in the follow-up period. One patient had palatal fistula and one patient had mild nasal mucosal atrophy. None of the patients had malocclusion in the postoperative period. The minimum follow-up period was 24 months. Conclusion: Maxillary swing procedure provides excellent exposure to skull base, and most of the tumors involving this region can be effectively excised with minimal morbidity to the patient.

Introduction: Residual defects of the palatal region following ablative resection of tumors and Gunshot wounds (GSWs) of the maxillofacial region can be quite painstaking, daunting and challenging to reconstruct, due to the extent and composite nature of the tissue loss. A shortage of available donor areas and local flap options in the intraoral region, add to the difficulty. Further compounding the situation, are factors such as excessive fibrosis and scarring of the palatal tissues as a result of multiple previous surgeries in the region. Objective: To evaluate the effectiveness of the Dorsal Pedicled Tongue Flap in the reconstruction of complex palatal defects resulting from maxillofacial GSWs and ablative tumor resections. To also device techniques to reduce the incidence of postoperative tongue flap detachment, thus improving its efficiency and reliability. Results: The palatal fistulas in all the patients were closed successfully, with no post-operative complications such as bleeding, hematoma formation, congestion, infection, partial or total flap necrosis or flap detachment. The tongue flap at the recipient site remained healthy with no recurrence of the fistula in any of the patients in the two years follow up period. There was a complete resolution of the problem of nasal regurgitation of orally ingested fluids and food particles. There was observed no deformity or articulation defect resulting from the flap harvested from the tongue dorsum, in any of the patients. Conclusion: In GSWs and tumor ablative surgery, where composite tissue defects are involved, the tongue provides a reliable and efficient means of restoring lost tissue bulk as well as ensuring a permanent closure and sealing off of the oronasal fistulas. Its reliability can be further increased by avoiding a common complication, namely, flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also, maintaining the patient on Nasogastric feeding for the three weeks postoperative period, until the patient is taken up for surgical separation the pedicle. This helps to ensure a successful and predictable take of the flap at the donor site.

Aim: 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. Materials and Methods: The series include study report of forty patients with secondary anterior palatal fistula post cleft palate repair, reported in a single unit during a duration of 3 years. All the cases were managed surgically under general anesthesia. The patients were classified depending upon the location of anterior palatal fistula (APF), the quality of tissue and age of patients to chalk out a justified treatment option outlay. Results: Forty cases were split for surgical correction into various options depending on their size, site, and quality of the tissue. Most of the cases were operated with a Bardach's Redo for fistula closure (n = 16) (40%) and crevicular flap technique (n = 13) (32.5%). Our overall success (satisfactory results) was 77.5% as observed in 31 out of 40 cases with individual success rates for Bardach's and crevicular being 75% and 77%, respectively. There was reduction in size of fistula in three cases (7.5%) and a remnant pinpoint hole in four cases (10%) among all the operated cases. Conclusion: Management of post palatoplasty fistulas of the hard palate presents a challenging situation for a clinician following the surgical correction of cleft palate. Current paper describes the diagnosis and clinical management of forty cases reporting with unilateral APF following cleft palate surgery, over 3 years. Authors have attempted to propose different treatment modalities for surgical management of unilateral APF. It was concluded in the primary review that the size of fistula was irrelevant in determining the clinical outcome. Instead, the quality and condition of the adjacent tissue appear to be the major governing factors for selecting treatment modality as well as the surgical consequences.

Context: Width of cleft palate influences difficulty of surgical repair and indirectly the outcome. Palatoplasty complicated with oronasal fistula causes persistence of speech, feeding, and social problems. Subsequent closure of palatal fistula has high recurrence rate. Aim: To determine the relationship between palatal cleft width and oronasal fistula. Setting and Design: One-year prospective nonblinded study. Materials and Methods: All consecutive patients with cleft palate that presented to the study institutions within the period, and met inclusion criteria were studied. The width of the palatal cleft defect was measured intraoperatively. Statistical Analysis Used: Chi-square and Mann-Whitney U-tests were used. P Results: Forty-six patients were studied out of 53 patients seen during the study period. These were 22 males and 24 females giving male to female ratio of 0.92:1. Patients' ages ranged from 10 months to 28 years; 52.17% of the study population were 2 years and below while 47.83% were aged over 2 years. Cleft width ranged from 4 to 25 mm. Nineteen patients developed fistula. Thus, the overall rate is 41.30%. Likelihood of fistula occurring increased as the width of cleft increased. Fistula rate was higher for patients with cleft width above 15 mm. Fistula rate for intravelar veloplasty was 30% and 50% for von Langenbeck repair; this was not statistically significant. Conclusion: Cleft width is a strong factor in the development of oronasal fistula. The fistula rate suggests a high burden of the problem. Efforts should be made to improve management outcome.

Background: Secondary palatal fistula and velopharyngeal insufficiency (VPI) are two major complications of palatoplasty. Various methods have been introduced for surgical repair of these complications; however, most of them are associated with a high recurrence rate and morbidity. This study was designed to evaluate the use of the buccinator myomucosal flap in the reconstruction of palatal fistula and velopharyngeal insufficiency following primary palatoplasty. Materials and Methods: This study was performed on 25 patients who had either secondary palatal fistula or velopharyngeal insufficiency. Their defects were repaired by buccinator myomucosal flaps (BMFs). Patients were followed for 8 weeks and follow-up visits were arranged at 1, 2, 4, and 8 weeks after discharge. Results: All BMFs were harvested and transposed successfully. The length of the soft palate increased 15.14 ± 1.13 mm postoperatively. One patient (4%) had flap dehiscence 6 days after the operation with no flap ischemia or necrosis. Another patient (4%) experienced recurrence of the palatal fistula with marginal necrosis of the BMF 6 weeks after the operation. Otherwise, no case of fistula recurrence, infection, flap ischemia or necrosis and donor-site morbidity was observed during follow-up sessions. Conclusion: This study demonstrated that using BMFs could be a safe, effective and promising method of treatment for post palatoplasty fistula and VPI. However, further investigations on a larger sample size with longer follow-up are recommended for more accurate conclusion.

Introduction: The cleft palate repair is commonly performed procedure in plastic surgery practices. In addition, this is also procedure done by trainees to the senior most surgeons. One of common procedure for trainee who are introduced to cleft lip and palate surgeries. Literature is flooded with articles on complication of cleft palate repair and probable factors influencing it till the latest one, which suggest that we are far from getting desirable results in cleft palate repair. Review: The common complications of cleft palate repair are fistulae, velopharyngeal insufficiency and detrimental effect on maxillary growth. Palatal fistula is commonly stated in literature with variable incidence ranging from 3-40% 1 , with an average of 7-10%. Other complications are poor speech outcome and poor growth potential of maxillary bone due to scars following palate repair. Every attempt needs to be made to avoid complications or reduce the rate of complications. This article reviews the factors and pitfalls that are likely to increase the chances of complication following palate repair. Conclusion: As surgeon we are duty bound to reduce the avoidable complication, specially related to judgment and techniques. However, the complication due to inherent deficiency of tissue like hypoplastic soft palate muscles and poor scarring tendencies leading to complications are not avoidable.

Large palatal fi stulas are a challenging problem in cleft surgery. Many techniques are used to close the defect. The tongue fl ap is an easy and reproductible procedure for managing this complication. The authors report a case of a large palatal fi stula closure with anteriorly based tongue fl ap.Key words: Cleft surgery, fistula, palate, tongue flap