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Current indications of maxillary reconstruction with scapular tip free flap (STFF) are palatoalveolar defects associated with zygomaticomaxillary buttress and/or orbital floor defects. STFF can be placed either horizontally or vertically. Horizontal placement usually allows ideal palatal conformation, preventing oronasal communication, but has been argued to compromise orbital support and projection of the midface, whereas vertical placement is advocated for midface support but may be insufficient for the complete closure of the palate. The present study focuses on the horizontal placing of STFF to allow complete palate reconstruction and fistulae prevention while still obtaining optimal midface projection and orbital support. This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed. None of the patients presented palatal fistulas or alterations in the orbital support. A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support. [Display omitted] [ABSTRACT FROM AUTHOR]

Palatal fistula is a complication of cleft palate surgery. It can be due to suture dehiscence, hematoma, infection, or flap necrosis. Palatal fistula treatment is a challenge to surgeons. Treatment of fistula depends on its size, location, and surgeon experience. Because of a paucity of nearby tissue, it usually demands the incorporation of extra tissue from the surroundings for a successful outcome. Tongue flaps and buccal myomucosal flaps can be employed to add tissue from the surroundings. In this study, we describe a patient with a large palatal fistula repaired in stages with a good surgical outcome.

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Objective: The objective of this study was to compare the incidence of palatal fistula formation between cleft palate (CP) repair with collagen matrix graft and conventional repair without collagen matrix graft. Patients and Methods: This was a preliminary randomized controlled study of patients with CP who underwent primary palatoplasty (two-flap palatoplasty technique) at the Lagos University Teaching Hospital. Patients were randomly allocated to either the test group (palatoplasty with collagen graft) or the control group (palatoplasty without collagen graft). The primary outcome was palatal fistula, and secondary outcomes were wound dehiscence, surgical site inflammation, surgical site infection, and surgeon satisfaction up to 3 months postoperative (PO). Results: Ten patients were recruited, five in each group. Only one patient in the control group developed a palatal fistula at 1 month PO on the soft palate which extended to the junction of hard and soft palate at 3 months PO. Eight patients developed wound dehiscence, five in the test group and three in the control group. Surgical site inflammation persisted up to at least 7 days PO in nine patients (five in the test group and four in the control group). All persistent wound dehiscence and surgical site inflammation resolved at 3 months PO. No patient developed surgical site infection. No significant difference was seen between the study group and wound dehiscence, surgery time, and difficulty of the procedure (P > 0.05 for all associations). Conclusion: Collagen graft may have a protective effect against fistula formation without significantly increasing surgery time and difficulty. However, due to the small sample size, the study failed to draw definite conclusions. Results from this study may inform future designs of larger randomized controlled studies.

Background: Repairing a wide cleft palate is a challenging task for surgeons. The goals of cleft palate repair such as achieving anatomical closure of the defect, complete velopharyngeal closure, speech development, and to minimize dentoalveolar anomalies are difficult to achieve in wide and massive cleft palates. Several methods have been described for the same. We performed double transposition flaps combined with intravelar veloplasty in our patients. In this article, we share our experience with the same. Materials and Methods: We reviewed 9 cases, in which double transposition flaps with intravelar veloplasty were performed. Patient demographics, clinical data, and outcomes were analyzed. Functional status including nasal resonance and palatal mobility were assessed with nasal endoscopy. Results: The average age at the time of surgery was 17 months. Four patients had associated diseases. The mean operative time was 55.7 min. The mean follow-up period is 23.7 months. Only posterior palatal closure was done in all the cases and patients were managed temporarily with obturators and are planned for delayed closure later. Conclusion: Double transposition flap is a safe, effective, and technically less demanding procedure. It has no wound complications and can avoid the need for osteotomy to correct maxillary retrusion. The main drawback of the procedure is the creation of an anterior palatal fistula that needs closure later.

Introduction: An oronasal fistula is a challenging post-operative complication of palatoplasty due to impaired velopharyngeal function or its high recurrence rate. Muscle repositioning, a key procedure in palatoplasty, causes dead space at the junction between the hard and soft palates. Consequently, thin oral and nasal mucosae are prone to break down and form fistulas. In this study, we used basic fibroblast growth factor-impregnated collagen gelatin sponge (bFGF-CGS) in primary palatoplasty to reduce fistula formation. Methods: This retrospective study assessed the complications and efficacy of bFGF-CGS to reduce fistula formation. Patients who underwent primary palatoplasty with bFGF-CGS were included. The same number of patients who underwent primary palatoplasty without bFGF-CGS was included as a control group. The outcomes included post-operative oronasal fistula formation, delayed healing, bleeding, and infection. Results: Both groups included 44 patients. Except for age at palatoplasty, there were no statistically significant demographic differences between the two groups; however, the rates of fistula formation in the study and control group were 2.3% and 13.6%, respectively. There were no infections among the patients. Conclusions: The grafting of bFGF-CGS in primary palatoplasty was safe and probably effective in reducing post-operative oronasal fistula formation.

Purpose: A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency. Methods: A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction. Results: Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, P <.001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, P =.757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤ P ≤.975). Conclusions: A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the incidence of palatal fistula formation between cleft palate (CP) repair with collagen matrix graft and conventional repair without collagen matrix graft. Patients and Methods: This was a preliminary randomized controlled study of patients with CP who underwent primary palatoplasty (two‑flap palatoplasty technique) at the Lagos University Teaching Hospital. Patients were randomly allocated to either the test group (palatoplasty with collagen graft) or the control group (palatoplasty without collagen graft). The primary outcome was palatal fistula, and secondary outcomes were wound dehiscence, surgical site inflammation, surgical site infection, and surgeon satisfaction up to 3 months postoperative (PO). Results: Ten patients were recruited, five in each group. Only one patient in the control group developed a palatal fistula at 1 month PO on the soft palate which extended to the junction of hard and soft palate at 3 months PO. Eight patients developed wound dehiscence, five in the test group and three in the control group. Surgical site inflammation persisted up to at least 7 days PO in nine patients (five in the test group and four in the control group). All persistent wound dehiscence and surgical site inflammation resolved at 3 months PO. No patient developed surgical site infection. No significant difference was seen between the study group and wound dehiscence, surgery time, and difficulty of the procedure (P > 0.05 for all associations). Conclusion: Collagen graft may have a protective effect against fistula formation without significantly increasing surgery time and difficulty. However, due to the small sample size, the study failed to draw definite conclusions. Results from this study may inform future designs of larger randomized controlled studies. [ABSTRACT FROM AUTHOR]

Background: Repairing a wide cleft palate is a challenging task for surgeons. The goals of cleft palate repair such as achieving anatomical closure of the defect, complete velopharyngeal closure, speech development, and to minimize dentoalveolar anomalies are difficult to achieve in wide and massive cleft palates. Several methods have been described for the same. We performed double transposition flaps combined with intravelar veloplasty in our patients. In this article, we share our experience with the same. Materials and Methods: We reviewed 9 cases, in which double transposition flaps with intravelar veloplasty were performed. Patient demographics, clinical data, and outcomes were analyzed. Functional status including nasal resonance and palatal mobility were assessed with nasal endoscopy. Results: The average age at the time of surgery was 17 months. Four patients had associated diseases. The mean operative time was 55.7 min. The mean follow‑up period is 23.7 months. Only posterior palatal closure was done in all the cases and patients were managed temporarily with obturators and are planned for delayed closure later. Conclusion: Double transposition flap is a safe, effective, and technically less demanding procedure. It has no wound complications and can avoid the need for osteotomy to correct maxillary retrusion. The main drawback of the procedure is the creation of an anterior palatal fistula that needs closure later. [ABSTRACT FROM AUTHOR]

Introduction: Pierre Robin syndrome is a malformative sequence associating retrognathism, glossoptosis and a median cleft palate which is usually large. This poses the problem of its therapeutic management. Purpose: To show the approach of the Stomatology and Maxillofacial Surgery Department of the Mohammed VI University Hospital in the management of cleft palate in Pierre Robin syndrome.This was a retrospective study, covering 5 years, which allowed us to include 7 cases of cleft palate in Pierre Robin syndrome. Our study parameters were epidemiological, clinical, therapeutic and evolutionary. Results: The average age of our patients, at the time of the 1st consultation, was 4 months. There was a slight male predominance with a sex ratio = 1.3. The patients presented a U-shaped cleft in 57.1% of cases, and a V-shaped cleft in 42.9% of cases. Three patients underwent a one-stage closure by velopalatoplasty using the Von Langenbeck technique. Four patients underwent a 2-stage closure, i.e., intravascular veloplasty in the first stage, followed by closure of the residual cleft palate in the second stage. The results were satisfactory. A palatal fistula was noted in 42.8% of cases, which was managed secondarily. Conclusion: The management of cleft palate in Pierre Robin syndrome is a real challenge for the maxillofacial surgeon.

The buccal fat pad, also called the Bichat's fat pad (BFP), is an encapsulated fat mass located in the cheek. This type of specialized fat mass can be used both as a pedicular or free graft in various surgeries and approaches. Due to its easy access from the oral cavity approach, it is commonly used for oroantral and palatal fistula closure. The knowledge of its anatomy and surrounding tissues plays a role in its mobilization and suturing onto the desired defect in the palatal or maxillary region. The BFP is mostly associated with the primary approach used for a fistula or bone surgery. Alternatively, the procedure can be performed with a single approach incision, which does not compromise the appearance or the function of the operating or adjacent areas. The most important inclusion criteria for BFP usage and surgical limitations are highlighted. The BFP is used for multiple purposes in reconstructive and oncology surgery and also has its use in esthetic and facial contouring procedures. The amount, volume, and shape of the BFP are mostly associated with the scope of their usage. The aim of the following narrative review is to present the surgical and anatomical implications of fat pads in maxillary and palatal surgeries. [ABSTRACT FROM AUTHOR]

Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy. [ABSTRACT FROM AUTHOR]

Postoperative palatal fistulas are common after surgery to correct a cleft palate. The repair is hindered by palatoplasty-related scar tissue, reduced vascularity, and restricted mobility of flaps. Surgical repair of fistulae is often effective, but recurrence is common. A 3.5-year-old boy presented with anterior palatal fistula. The presence of peri-fistulous scarring prevented two-layered closure. Nasal layer closure was achieved but not the oral layer. The dermal matrix was reinforced in a one-step procedure over the nasal layer and fixed in place using a gel foam. At 6 months, the fistula almost completely healed, with only a pinpoint track remaining that occasionally leaked into the nasal cavity. These results indicate that the application of dermal matrix is a promising technique to repair fistula with surrounding scarring, but larger, prospective trials are needed to confirm its potential benefits.

A palatal fistula is a pathological condition that connects the nasal cavities with the oral cavity. An oral–nasal fistula is reported as a possible post-surgical complication after the removal of oral carcinomas. The presence of a palatal fistula affects the patient's quality of life, making it necessary to apply a prosthetic device, such as a palatal plate, to keep the nasal cavities separated from the oral one. There are several surgical techniques to close a palatal fistula, but it is not possible to define the optimal technique as the approach is extremely dependent on the characteristics of the fistula. The aim of this article is to propose a minimally invasive technique to reduce the size of palatal fistulae and to reduce the surgical difficulty (NSPF). A total of 20 patients fulfilled the inclusion criteria and were checked every two weeks. The fistula was injured with a needle every 2 weeks. Fifteen patients who healed with complete closure of the fistula reported no need for a palatal protection plate to eat, drink and speak normally. It is possible to conclude that the NSPF protocol is a valid approach for the non-surgical reduction of palatal fistulae, and it is possible, when the appropriate conditions are present, to achieve complete closure. [ABSTRACT FROM AUTHOR]

Introduction:Large anterior palatal fistula and special alveolar clefts, such as edentulous atrophic premaxilla and absent premaxilla (premaxillectomy or agenesis), as well as wide unilateral alveolar cleft, are complicated cases in alveolar cleft bone grafting surgery. A superiorly-based buccinator myomucosal flap is suitable in this regard. Materials and Methods:The cleft patients whose large anterior palatal fistula and superiorly based buccinator myomucosal flap had been used for palatal or alveolar reconstruction were recruited in the study. The reconstruction method of the nasal floor, follow-up time, and hospital length of stay were recorded. Results:A total of 10 patients had been treated by this method. The majority of them were male (6/10), the age range of the patients was 14-25 years. All flaps survived and a case of partial necrosis occurred. Conclusion:As evidenced by the obtained results, a superiorly-based facial artery musculomucosal flap is suitable when the palatal fistula is continuous with the alveolar cleft. Transmaxillary transfer is the other option in patients with closed maxillary arch.

Postoperative fistulae are one of the most significant complications of cleft palate repair. They usually has an adverse effect on patients’ oral hygiene, speech and even mental health. There has been a wide range of rates of fistula occurrence, from 0.8%-60%, with the classification and definition of fistulae differing from one author to the next. In this paper, the definition and classification of palatal fistulae and their reconstruction method are reviewed. At present, there is a lack of a consistent definition of palatal fistulae and a classification that can fully reflect the characteristics of palatal fistula. Adjacent flap is mainly used for repairing small fistulae with an adequate amount of surrounding tissue; anteriorly based dorsal tongue flaps are a safe and reliable method for large fistulae; free flap is beneficial for refractory and complicated palatal fistulae that are difficult to repair by the local and pedicle flap; and different synthetic materials are used in multilayer repair of fistulae; among them, composite polymer membrane is highly biocompatible, promoting cell attachment and proliferation in animal models, but its security in the human body needs further research.

Postoperative palatal fistulas are common after surgery to correct a cleft palate. The repair is hindered by palatoplasty-related scar tissue, reduced vascularity, and restricted mobility of flaps. Surgical repair of fistulae is often effective, but recurrence is common. A 3.5-year-old boy presented with anterior palatal fistula. The presence of peri-fistulous scarring prevented two-layered closure. Nasal layer closure was achieved but not the oral layer. The dermal matrix was reinforced in a one-step procedure over the nasal layer and fixed in place using a gel foam. At 6 months, the fistula almost completely healed, with only a pinpoint track remaining that occasionally leaked into the nasal cavity. These results indicate that the application of dermal matrix is a promising technique to repair fistula with surrounding scarring, but larger, prospective trials are needed to confirm its potential benefits. [ABSTRACT FROM AUTHOR]

Aim of the study: To evaluate the use of dermis-fat graft as autogenous tissue to achieve three layers closure of the palatal fistula. One of the most devastating complication that follows cleft palate surgery is oro- nasal fistula. It can lead to many problems like fluid and food regurgitation, poor oral hygiene and retropharyngeal incompetence. The repair of palatal fistula had long presented a remarkable challenge to the plastic surgeon. Repair of these fistulae required the use of more than the usual two-layered closure procedures; demanding the introduction of a 'Third layer' of tissue to enhance smooth healing, and thereby reduce the chance of closure failure which predispose to fistulization. In this study we used an autogenous graft of " dermis and fat (dermis-fat) graft " to serve as the third protective, supportive and enhancive layer. [ABSTRACT FROM AUTHOR]

Introduction: Large anterior palatal fistula and special alveolar clefts, such as edentulous atrophic premaxilla and absent premaxilla (premaxillectomy or agenesis), as well as wide unilateral alveolar cleft, are complicated cases in alveolar cleft bone grafting surgery. A superiorly-based buccinator myomucosal flap is suitable in this regard. Materials and Methods: The cleft patients whose large anterior palatal fistula and superiorly based buccinator myomucosal flap had been used for palatal or alveolar reconstruction were recruited in the study. The reconstruction method of the nasal floor, follow-up time, and hospital length of stay were recorded. Results: A total of 10 patients had been treated by this method. The majority of them were male (6/10), the age range of the patients was 14-25 years. All flaps survived and a case of partial necrosis occurred. Conclusion: As evidenced by the obtained results, a superiorly-based facial artery musculomucosal flap is suitable when the palatal fistula is continuous with the alveolar cleft. Transmaxillary transfer is the other option in patients with closed maxillary arch. [ABSTRACT FROM AUTHOR]

Abstract Background The cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth. Methods A retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children’s Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes. Results Twenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4). Conclusions There was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth.

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.

Background Many surgical protocols are available for the management of unilateral cleft lip and palate (UCLP). The two-stage protocol (repair of cleft lip at 3–4 months old, followed by repair of cleft palate at the age of 10–18 months) is a common practice in cleft centers, including our hospital. One-stage simultaneous repair of both cleft lip and palate has been adopted in many cleft centers with satisfactory results; the main advantages of this protocol are lower theoretical costs and less use of operative facilities. The aim of this study was to compare the two different surgical protocols in children who were operated on for UCLP. Patients and methods A randomized controlled trial was conducted on 32 consecutive patients with unoperated UCLP, who were allocated into two groups: group A, which consisted of 14 patients consecutively treated with one-stage simultaneous closure of the lip and hard and soft palate, and group B, which consisted of 18 patients who underwent cleft lip repair and cleft hard palate repair with a vomer flap on the first sitting, and then, repair of the remaining cleft soft palate was performed in the second sitting. The two study groups were evaluated regarding the duration of surgery, the need of intraoperative blood transfusion, postoperative complications in the form of respiratory distress, soft palate disruption, and palatal fistula occurrence, for at least 6 months following one-stage repair in group A and 6 months after soft palate repair in group B. Results Both groups were comparable regarding mean age at first operation (P=0.056), sex distribution (P=0.821), total duration of surgeries (P=0.363), and need for postoperative intubation (P=0.568). There was no significant difference in prevalence of postoperative palatal fistula (P=1.000) and soft palate disruption (P=0.142) between both groups. Conclusion Both one-stage and two-stage protocols showed comparable outcomes regarding the prevalence of postoperative palatal fistula and soft palate dehiscence. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess the incidence of palatal fistula after primary repair of the cleft palate among two cohorts of Otolaryngologist‐Head and Neck Surgeons and to identify patient and surgeon characteristics that may predict fistula development. Study Design: Retrospective case series with chart review. Methods: Children who underwent primary repair of cleft palate at one of two multidisciplinary cleft centers over a 10 year period were identified. Charts were reviewed for the presence of palatal fistula; chi square test and multivariate logistic regression analysis were performed to determine variables associated with fistula formation. Results: From 2007 to 2017, 477 patients underwent primary repair of cleft palate by one of 6 Otolaryngologist‐Head and Neck Surgeons. Twenty‐four children had incomplete charts, allowing 453 patients to be included in the final analysis. The pooled mean incidence of palatal fistula was 6.6% (P =.525) and varied significantly by cleft type. Logistic regression analysis controlling for multiple variables, showed that Veau IV classification had the highest risk of fistula (OR = 10.582; P =.004). Repair by a specific surgeon was not a significant risk factor for fistula development (P >.07 for each surgeon). Conclusions: Among six Otolaryngologist‐Head and Neck Surgeons with fellowship training in cleft palate repair postoperative fistula rates were consistent and compared favorably to standards in the Cleft and Craniofacial surgery literature established by other surgical specialties. Consistent with larger database studies involving multiple surgical specialties, Veau IV classification was the strongest predictor of palatal fistula development, even after adjusting for multiple variables, including differing levels of experience. Level of Evidence: 4 Laryngoscope, 131:1281–1285, 2021 [ABSTRACT FROM AUTHOR]

Palatal fistula after primary palatoplasty remains one of the most difficult complications that plastic surgeons have to face. Once the fistula has developed, the complexity of the reconstruction increases significantly, and the revisional surgery results are not promising. The recent use of acellular dermal matrix (ADM) provides a new perspective for the reconstructive surgeon. Our goal is to reduce and prevent the postoperative oronasal fistula in patients with cleft palate by placing an ADM in the zone 3 and 4 of Pittsburgh (hard palate and hard–soft palate junction), creating an extra layer for support of the cleft palate. Seven children diagnosed of palatal cleft with high risk of developing oronasal fistula were operated. The technique of choice was two-flap palatoplasty with lateral incisions and intravelar veloplasty and three-layered closure with ADM in the hard palate and hard–soft palate junction. One patient developed a 3-mm oronasal fistula at 3-month follow-up, with spontaneous closure at 12 months. The rest of the children had an uneventful evolution. Our rate of postoperative oronasal fistula was 0% at 12 months. The use of ADM in primary palatoplasty had been of great use to prevent complications in high-risk oronasal fistula patients.

Background: Conventional treatment for cleft lip and palate patients is lip repair at three to four months and then palatal repair at nine to 12 months of age. However, for the patients who delay seeing a doctor especially in a developing area such as Northern Thailand, simultaneous lip and palate repair is performed at 12 to 18 months of age or later, depending on the age at the first visit. It is a common belief that patients with cleft lip and palate will be behind non-cleft patients in early development phonemes because of the open palate. This delay persists until the palate is repaired and on into the postoperative period. This proposition has not been proven with longterm clinical outcomes in one-stage repairs. Objective: To investigate the effects of one-stage repair on speech assessment, hearing, and incidence of palatal fistula. The results were compared with conventional two-stage surgical repairs. Materials and Methods: The present study was designed two groups. Group 1 consisted of 25 children (mean age 11.28±1.93 years) treated with a one-stage repair. Cleft lip, palate, and alveolus were repaired at a single surgical session in the first 18 months of life (mean age at the time of surgery 13.52±4.51 months). Group 2 consisted of 17 children (mean age 11.02±2.23 years) treated in two-stage surgical repairs. Lip repair was performed at a median age of 4.01 months (IQR 3.62 to 5.46), and palate repair was performed at a mean age of 13.54±4.14 months. Both groups underwent cleft lip and palate repairs at the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University between January 1, 2004 and December 31, 2010. Speech and hearing for all patients were evaluated by experienced ENT doctors. The palatal fistula was evaluated by the same plastic surgeons. Results: One-stage repair showed significant normal articulation and less articulation disorder when compared with two-stage surgical repairs. However, no significant difference was determined for other speech assessments, hearing, and incidence of palatal fistula. Conclusion: Because one-stage repair seems to have a more positive influence on articulation, and both surgical treatment protocols give similar results on speech assessments, hearing, and incidence of palatal fistula, regardless of the timing of the surgery, the onestage repair is not inferior to conventional two-stage surgical repairs for patients in developing areas. This is due to several important advantages, such as less hospitalization, lower cost, and less chance of nosocomial infection. [ABSTRACT FROM AUTHOR]

Background: Cleft palate repair may be compromised by a number of complications, most commonly the development of a fistula. Fistulas may cause hypernasal speech, articulation problems and food or liquid regurgitation from the nose. Objective: The study determines the incidence and management of cleft palatal fistulas in a series of primary cleft palate repair surgeries. It is a retrospective analysis of total 185 palatal fistula cases operated at our hospital from the year 2004 to 2016. Subjects and Methods: Of 185 palatal fistulas, 132 cases had been operated at our institute for primary palatoplasty, and the rest 53 were the outside-operated cases. The patients with bilateral as well as unilateral cleft lip and palate were included. Isolated cleft palate patients were also included in the study. Palatal fistulas were subdivided into three types depending on their size. Anterior palatal fistulas were mostly treated by using tongue flap (65.57%), followed by local flaps (34.43%). Middle and posterior palatal fistulas were mostly treated by von Langenbeck Palatoplasty. One patient (>5 mm fistula) was treated using free radial forearm flap. Results: Anterior palatal fistulas (65.57%) were most commonly reported, followed by middle (24.86%) and posterior (9.18%). Most commonly, the size of the fistulas ranged from 2 mm to 5 mm. The complication rate was reported to be 3.75% in case of tongue flap and 11.9% complications were reported in case of local flaps. Conclusion: Tongue flap remains the flap of choice for managing very difficult and challenging anterior palatal fistulas compared to local flaps.

Abstract Objective To determine frequency of palatal fistula following primary cleft palate repair and the associated factors as a measure of cleft palate repair outcome and its challenges at a cleft centre in Uganda. Results Between May and December 2016, 54 children with cleft palate were followed up at Comprehensive Rehabilitation services of Uganda (CoRSU) hospital, from time of primary cleft palate repair until at least 3 months postoperative to determine whether they developed palatal fistula or not. Frequency of palatal fistula was 35%. Factors associated with increased fistula formation were cleft width wider than 12 mm (p = 0.006), palatal index greater than 0.4 (p = 0.046), presence of malnutrition at initial outpatient assessment (p = 0.0057) and at time of surgery (p = 0.008), two-stage palate repair (p = 0.005) and postoperative infection (p = 0.003). Severe clefting (palatal index greater than 0.4) was seen in 74% of patients and malnutrition (Low weight for age) seen in 48% of patients. Palatal fistula rates at our institution were high compared to reports in literature. The high proportions of severe clefting and malnutrition observed in our population that was also poor and unable to afford feeding supplements increased likelihood of fistula formation and posed challenges to achieving low fistula rates in our setting.

Candida osteomyelitis affecting maxillofacial bones has been scantly documented in the literature. Infantile osteomyelitis is an uncommon and life-threatening disease. Candida osteomyelitis causes significant morbidity. The present report describes a case of a 9-month-old infant with infantile osteomyelitis secondary to Candida infection. This report describes its presentation and the management of palatal fistula in an infant. [ABSTRACT FROM AUTHOR]

Large palatal fistulas after cleft palate surgery are difficult to treat using local mucoperiosteal flaps alone, particularly if multiple attempts to close the fistulas have resulted in tissue scarring. In this study, we present our 15-year surgical experience with tongue flaps for large palatal fistulas. A total of 34 patients who underwent tongue flap surgery at our institution between January 2000 and January 2015 were retrospectively analyzed. An anteriorly-based dorsal tongue flap was used for the treatment of anteriorly localized large palatal fistulas in all patients. Data including demographic characteristics of the patients, previous surgeries, localization of the fistula, time between the first and second surgery, and complications were recorded. Factors affecting the surgical success were evaluated. Of the patients, 21 were males and 13 were females with a mean age of 11.7 ± 6.9 (range: 4 to 29) years. Detachment of the tongue flap was observed in nine patients after surgery. Seven of the patients with detachment were male aged ≤6 years (p < 0.05). Resuturing the flap back to the defect did not significantly affect the results. Our study results suggest that proper patient selection and attentive and rigorous surgical technique have a critical importance in the tongue flap repair and tongue flap is not recommended for patients who are under seven years of age. [ABSTRACT FROM AUTHOR]

BACKGROUND: Digital impression technology has been widely used in the oral field. Compared with traditional impression technology, it is more convenient and accurate. OBJECTIVE: To explore the application of digital prosthesis for repairing palatal fistula in rabbits. METHODS: The rabbit models of palatal fistula were established by surgery. One month later, 10 rabbit models of palatal fistula were scanned by digital intraoral scanning system. The medical silicone rubber prosthesis for palatal fistula was manufactured by digital impression technology and digital design. After wearing the prosthesis, the accuracy, retention and sealing properties of the prosthesis were examined. The study was approved by the Laboratory Animal Ethical Committee of Hospital of Stomatology, Southwest Medical University. RESULTS AND CONCLUSION: After digital prosthesis repaired palatal fistula, the accuracy, retention and sealing properties of the prosthesis were good. To conclude, the digital prosthesis for palatal fistula repair by digital impression technology achieves accurate repair, and has certain clinical values. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The cause of maxillary growth restriction in patients with cleft lip and palate remains controversial. While studies have investigated the effects surgical technique and timing have on maxillary growth, few focus on patients with isolated cleft palate (ICP). The purpose of this study was to determine the impact palate repair and its associated complications may have on maxillary growth. Methods: A retrospective chart review of ICP patients who underwent palatoplasty from 1962 to 1999 at Akron Children's Hospital was performed. Patient demographics, Veau type, age at primary repair, closure technique, presence of fistula or velopharyngeal insufficiency (VPI), number of palatal operations, maxillary hypoplasia (MH) frequency, and follow-up were recorded. Exclusion criteria included patients with cleft lip, submucous cleft, or syndromes. Results: Twenty-nine non-syndromic ICP patients were identified; 62% (n = 18) had Veau type 1 and 38% (n = 11) had Veau type 2. All patients underwent 2-flap or Furlow palatoplasty with mobilization of mucoperiosteal flaps. Vomerine flaps were used in all Veau 2 cleft palate closures. Palatoplasty was performed at a mean age of 19.9 ± 8.2 months. Average follow-up was 209 ± 66.5 months. The rate of VPI was 59% (n = 17) and the rate of oronasal fistula was 14% (n = 4). Conclusions: There was a low incidence of MH despite complications after initial palate closure. Our results seem to suggest that age at palate closure, type of cleft palate, and type of surgical technique may not be associated with MH. Additionally, subsequent procedures and complications after primary palatoplasty such as VPI and palatal fistula may not restrict maxillary growth. [ABSTRACT FROM AUTHOR]

Objectives: Despite improved techniques in repair of cleft palate, failure of healing of palatal structures resulting in a palatal fistula is one of the major challenges in the practice of reconstructive surgery. The aim of this study is to evaluate treatment success and failure in patients with palatal fistulas following cleft palate repair. Patients and Methods: Totally 44 patients with a history of cleft palate who underwent surgery for palatal fistula were included in this study undertaken between January 1999 and August 2014. Fistulas were classified as anterior and posterior according to the repair technique and were repaired using one of the following techniques: buccal mucosal flap, tongue flap or mucoperiosteal flap. Results: Success rate for anterior fistulas was 71.42% with tongue flap and 76.92% with mucoperiosteal flap. Success rate for posterior fistulas was 84.62% with mucoperiosteal flap and 75% with buccal mucosal flap. Difference in success rates between the anterior and posterior fistulas was not statistically significant. Conclusion: Our study results suggest the use of mucoperiosteal flaps for both anterior and posterior fistulas smaller than 5mm as the first choice, guided by the principle of replacing absent tissue with similar tissue. [ABSTRACT FROM AUTHOR]

Purpose: A palatal fistula is an adverse outcome of cleft palate repair. It is unknown if a palatal fistula will influence velopharyngeal closure, even after repair of the fistula. This study determines the effect of a soft palate fistula on the risk of developing velopharyngeal insufficiency., Methods: A retrospective chart review was conducted on patients who underwent primary cleft palate repair between 2000 and 2015, with complete records at 4 years of age. Fistulae involving the secondary palate following primary palatoplasty were classified as the soft or hard palate. A forced-entry multivariate logistic regression model was built to detect predictors of velopharyngeal dysfunction., Results: Records of 329 patients were analyzed with a mean follow-up of 8.7 years. A palatal fistula was identified in 89/329 patients (27%) and 29/329 patients (9%) underwent an independent fistula repair. Of the patients with fistula, 44% were located in the hard palate only and 56% had soft palate involvement. Compared to patients without a fistula, rates of velopharyngeal dysfunction were significantly higher in patients with a fistula involving the soft palate (OR 3.875, CI: 1.964-7.648, P  < .001) but not in patients with a hard palate fistula (OR 1.140, CI: 0.497-2.613, P  = .757). Veau class, age at primary repair, and syndromic status were not significant predictors of VPI (0.128≤ P  ≤ .975)., Conclusions: A palatal fistula involving the soft palate is a significant predictor for development of velopharyngeal dysfunction after primary palatoplasty. Surgical intervention, at the time of fistula repair, to add vascularized tissue may be indicated to prophylactically decrease the risk of velopharyngeal dysfunction., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Copyright of Revista Médica de Rosario is the property of Circulo Medico de Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article aims to highlight palatal actinomycosis osteomyelitis as an unseen complication of maxillary tooth impactions. A middle aged male with uncontrolled diabetes reported with a complaint of nasal regurgitation of fluids. After clinical and radiographic evaluation, he was diagnosed with actinomycosis osteomyelitis of the hard palate as a sequelae of a long-standing palatally impacted tooth. He was treated by a combination of medical and surgical therapy. Palatal actinomycosis should be considered a differential in nonhealing lesions of the hard palate and a possibility before leaving maxillary impactions untreated, especially in immunocompromised individuals. Adequate follow-up is mandatory to note for any radiographic changes and if diagnosed, treatment should be started promptly to prevent grave complications. [ABSTRACT FROM AUTHOR]

Abstract Objective Oronasal fistula (ONF) is an abnormal communication between the oral and nasal cavity. It may arise in consequence to iatrogenic injury, neoplasms, trauma or following cleft palate repair. Closure of palatal fistula can be achieved by local and regional flaps. These procedures are often cumbersome and leave a raw nasal/oral surface which may increase the incidence of postoperative problems. The reported recurrence rate of the fistula is between 37% - 65%. The present paper demonstrates the versatility of the rhomboid flap in the closure of ONF in a two-layered fashion to avoid recurrence and donor site morbidity. Methods Seven patients (male, 6; female, 1) underwent reconstruction with Limberg flap for traumatic oronasal fistula of size less than 15 mm in its greatest dimension. The mucoperiosteum was first elevated gently and inverted to close the nasal side as a hinged flap, followed by the Limberg rhomboid flap, raised from one corner of the defect to provide tension-free closure of the oral surface. Results The fistula was completely closed in all cases at the first attempt, without any peri- operative complications. All fistulas successively healed, and none of our patients developed any significant postoperative bleeding, infection or fistula recurrence during the entire follow-up period of 6-9 months. Conclusion This study elucidates that Limberg flap procedure can be performed for managing oronasal fistula with a low complication rate, short hospital stays, and good long-term results. It can be used as an alternative to the existing conventional techniques in the closure of ONF. [ABSTRACT FROM AUTHOR]