Surgical Management of Anterior Palatal Fistula Post Cleft Palate Repair, Mansoura Experience

Document Type : Original Article

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The Department of Pediatric Surgery, Faculty of Medicine, Mansoura University

Abstract

Background: After cleft palate surgery, secondary palate fistulas are often seen problems. Anatomically shorter lesser segments, broad palatal cleft defects with thin palatal ledges, inappropriate reflection of subperiosteal flap, and faulty closure are the likely causes of anterior palatal fistulas (APFs). Because of its extreme fibrosis and scarcity of tissue, APFs surgery is among the most difficult. Aim of Study: The aim of this retrospective study was to evaluate the different surgical treatment for repair of Anterior palatal fistula depending upon their size and age, and also to assess the treatment outcome. Patients and Methods: In the Pediatric Surgery Department of the Faculty of Medicine, Mansoura University Children Hos-pital, from April 2019 to December 2021, 55 patients with sub-sequent anterior palatal fistula following cleft palate surgery are included in this study. Thirty-six patients were addressed by primary repair only, eight individuals by primary repair with unilateral buccinator myomucosal flap, six patients by primary repair with local palatine flap, and thirty-five patients by supe-riorly based labial flap. Results: Incidence of fistula recurrence of total 55 cases was 18 cases (32.7%). 28 patients (80%) from 35 patients who were managed by primary repair with superior based labial flap were successfully repaired, 5 cases (62.5%) from 8 patients that were managed by primary repair with unilateral buccina-tor myomucosal flap were successfully repaired, and 3 cases (50%) with successful repair from 6 patients who were man-aged by primary repair with local palatine flap, but only one case (16.7%) with successful repair from 6 patients who were managed by primary repair. Conclusion: Anterior palatal fistula is one of the most chal-lenging surgery due to excessive fibrosis and lack of tissue. Pri-mary repair with superior based labial flap and primary repair with unilateral buccinator myomucosal flap carry better results than primary repair with local palatine flap or primary repair only. Also, the quality and condition of the adjacent tissue ap-pear to be the major governing factors for selecting treatment modality as well as the surgical consequences.

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