Purse String Suture Closure: A Useful Double-Layer Technique for Closure of an Oronasal Communication

Abstract

Introduction: Various treatment modalities are reported in the literature for the management of oronasal communication. Single-layer closure often leads to failure and persists a major concern to an operative surgeon. Therefore, double-layer closure is one of the keys to successful management of oronasal communication.

Meterial and method: A continuous intramucosal running purse string suture at submucosal depth was placed circumferentially around the defect margin with 3-0 round body polyglactin suture as a first layer. Pedicled palatal rotation axial flap based on greater palatine artery was used as the second layer of closure, above the first palatal submucosal layer.

Conclusion: Intramucosal purse string suture technique provides adjacent local tissue for closure of oronasal communication. This technique is easy and can be used as an alternative option for double-layered closure of an oronasal communication, without donor site morbidity and minimal patient discomfort.

Keywords: Oronasal communication; Palatal rotation flap; Purse string suture.

Fig. 1

Linear oronasal communication measuring 2 × 0.5 cm

Fig. 2

a Illustration depicting a linear oronasal communication with intramucosal purse string suture. b Complete closure of defect with purse string suture end pulled taut and tied at one end and inward movement of mucosa into nasal cavity

Fig. 3

First-layer closure with purse string suture technique

Fig. 4

Second-layer closure with pedicled palatal rotation flap