Closure of complicated palatal fistula with facial artery musculomucosal flap

Abstract

Background: Palatal fistulas occur most commonly as a complication of cleft palate surgery. Treatment of these fistulas, especially when they are wide and scarred, is a challenge for both patients and plastic surgeons, with a high rate of recurrence.

Methods: The authors have operated on 22 cases of wide, scarred, recurrent palatal fistula with the use of the facial artery musculomucosal flap, first introduced by Pribaz et al. in 1992. The patients were operated on from March of 2001 to December of 2002 and ranged in age from 2 to 21 years. This flap is axial, centered over the facial artery, and can be raised inferiorly based or superiorly based. All of these patients with cleft palate had been operated on before. In one case, because of a very wide fistula, a bilateral facial artery musculomucosal flap was used.

Results: There were two cases of partial necrosis and one case of complete failure, probably caused by twisting of the whole pedicle. The nasal lining was made using turndown flaps of the fistula margin. Because of hanging the base of the flap (inferiorly based) and producing bite block during mastication, the pedicle had to be divided and the flap inset secondarily 1 month later.

Conclusions: The facial artery musculomucosal flap is an alternative for closing the scarred, wide, recurrent fistula, and is associated with a high rate of success. The flap should be included among the techniques of any plastic surgeon who performs palatal surgery.