title: Elimination of palatal fistula after the maxillary swing procedure.
abstract: BACKGROUND
  The maxillary swing procedure has been used as an anterolateral approach to expose the nasopharynx, the central skull base, and its vicinity. The reported incidence of postoperative palatal fistula has ranged from 20% to 25%. The oronasal incompetence especially associated with a large fistula has adversely affected normal speech, eating, and swallowing functions. We describe a modified palatal incision to reduce the incidence of palatal fistula associated with the maxillary swing procedure.
  
  
  METHODS
  Fifteen consecutive patients who underwent maxillary swing procedures for salvage resection of recurrent nasopharyngeal carcinoma after radiotherapy had the modified palatal incision. The flap was raised as described, and the outcome was analyzed.
  
  
  RESULTS
  Fourteen patients' palatal wound healed uneventfully. One patient experienced partial flap necrosis, which healed with conservative treatment. All 15 patients tolerated oral feeding 1 week after the surgery. No palatal fistulas occurred.
  
  
  CONCLUSIONS
  The modified palatal incision as described has effectively prevented palatal fistula formation after the maxillary swing procedure.
authors.affiliation: Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
authors.forename: Raymond W M
authors.initials: RW
authors.lastname: Ng
authors.forename: William I
authors.initials: WI
authors.lastname: Wei
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D009061:Mouth Mucosa / Q000601:surgery*; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D016155:Oral Fistula / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D021362:Palate, Hard / Q000601:surgery*; D010160:Palate, Soft / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome