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BULLET and shrapnel wounds of the face frequently penetrate the osseous walls of the maxillary antrum or the floor of the nasal fossae. Ranging downward in their course, these foreign bodies pass through the roof of the mouth, creating large and frequently multiple defects in the hard palate. These deficiencies may represent oronasal or oroantral fistulas. This type of injury is commoner than is generally supposed, because the face is the one part of the head that is unprotected by the helmet. A great many wounds of the face are due to sniper fire from an elevation such as a tree or a hill, which gives the bullet its characteristic downward course. The thick walls of the malar and the maxillary bone afford some measure of protection to the tongue and other contents of the oral cavity, as in most instances the velocity of the projectile is spent somewhat in

After a brief survey of the methods of closing palatal fistulas, a new operative method is presented. This method makes it possible to close relatively easily fistulas up to a diameter of 2 cm in a one-stage operation. The method is simple and has also proved reliable.

The syndrome of defects which characterise the cleft lip and palate patient undergoing secondary surgery is listed, and the traditional system of multiple sequential operations for its correction is challenged. A single stage combined procedure is described which permits the correction of maxillary collapse and hypoplasia to be combined with closure of an anterior palatal fistula and lip revision, together with some improvement of abnormal nasal appearance.

Background: Adult primary palatoplasty is more challenging tha n in infants because the gaps are wider. The risk ofintraoperative bleeding and palatal fistula are higher. Most adults with un-operated palatal cleft have good maxillary growth but poor speech. The aim of this study is to introduce our technique in repairing wide cleft palate in adult patients. Patients and Methods: We report four patients with cleft palate who underwent palatoplasty at adulthood. The age ranges from 17 to 20 years. Interspina distance were between 2 to 3.5 cm. All of them were nonsyndromic and had normal maxillary growth. The surgical technique used on these patients was two-flap palatoplasty with an additional 3 mm gingival bulk on the lateral side of the flap. Honey was given as oral drops postoperatively. Result: Lateral palatal defect healed well and epithelialized completely between 7 -14 days postoperative and only one small palatal fistula was found with this modified technique. All subjects had good maxillary growth, and speech outcome was poor to begin with.Summary: Two-flap palatoplasty can adequately provide palatal closure, especially with an additional lateral flap extension to include gingival components. This extension widens the flaps and aid palatal closure by not leaving lateral defects too wide.

Background: Cleft lip and/or palate (CL&/P) is the most common congenital craniofacial abnormality, affecting approximately 1 in every 700 newborns. Patients with cleft lip and/or palate (CL&/P) generally display poor oral hygiene and a higher prevalence of caries. This may be due to the difficulty in achieving adequate plaque control associated with dental anomalies and defects from the lips and/or palate. Palatal fistula is a significant complication following cleft palate repair. It is the aim of this research to find correlation between palatal fistula and dental caries. Patient and Method: Patients with unilateral complete cleft palates admitted to the Cipto Mangunkusumo hospital, Adam Malik hospital within the period July 2012 till March 2013 were included in this study. All cases underwent modified two flap palatoplasty leaving lateral periosteum technique and follow-up were done in two weeks to see if there are any palatal fistula. Result: Thirty eight patients with unilateral cleft palate were enrolled in the study. Fifteen (39.5%) of them are boys and 23 (60.5%) are girls. Fifteen of the patients (41.7%) had dental caries, with six patients (40%) had palatal fistula in the follow up after palatoplasty, while there was none (0%) of the 21 (58.3%) patients that were found negative for dental caries developed a fistula. Conclusion: Dental caries is one of the important predisposing factors of palatal fistula in patients who undergo palatoplasty.