title: Easy closure of anterior palatal fistula with local flaps.
abstract: BACKGROUND
  Anterior palatal fistula is often observed in the treatment of the cleft palate with a push-back palatoplasty. High rate of incomplete closure is reported. We describe a reliable new technique with reverse local flaps to close an anterior palatal fistula.
  
  
  METHODS
  One hundred seventeen cleft patients, treated with push-back palatoplasty, underwent repair of an anterior palatal fistula by our group. Fistulas were located in the anterior hard palate, with a variable size between 0.1 cm to more than 0.5 cm. Two reverse local flaps from the nasal mucosa of the lateral palatal edges are used to close the fistula. A third flap is elevated from the premaxilla in bilateral clefts. The flaps are elevated toward the center of the fistula. The closure is made in 2 layers for unilateral cleft and in 3 layers for bilateral cleft, using absorbable sutures.
  
  
  RESULTS
  Complete closure of the anterior palatal fistula was achieved in 77 patients (65%) after the first surgery, 27 patients (23%) required a second attempt to close the fistula, and 10 patients (8.5%) required a third surgery. Three patients (2.5%) continued to have a fistula after 5 surgeries.
  
  
  CONCLUSIONS
  We believe that our method is reliable and easy to perform, and it has a high success rate. The technique is indicated to correct small- to medium-size defects.
authors.affiliation: Department of Head and Neck Surgery, Second University of Naples, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Freda
authors.forename: Raffaele
authors.initials: R
authors.lastname: Rauso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curinga
authors.forename: Marco
authors.initials: M
authors.lastname: Clemente
authors.forename: Giulio
authors.initials: G
authors.lastname: Gherardini
mesh_terms: D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016155:Oral Fistula / Q000209:etiology / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome