title: Novel use of osmotic tissue expanders to treat difficult anterior palatal fistulas.
abstract: OBJECTIVE
  Novel use of osmotic tissue expanders to recruit local palatal mucoperiosteum for the treatment of difficult anterior palatal fistulas.
  
  
  METHODS
  This is a retrospective review of our experience with osmotic tissue expanders for closure of secondary palatal fistulas.
  
  
  METHODS
  The study occurred at Oregon Health and Science University, a tertiary care level academic hospital.
  
  
  METHODS
  All patients were treated for combined cleft lip and palate by the Oregon Health and Science University Craniofacial Disorders multidisciplinary team. They were determined to be appropriate candidates due to the anterior location of the fistula and symptomatic nature. Patients complained of significant nasal regurgitation of liquid and solids.
  
  
  METHODS
  All patients underwent a two-stage procedure under general anesthesia. The first stage was placement of the expanders. The second stage was 1 week later, with removal of the expanders, palatal revision, and closure of the oronasal fistula.
  
  
  METHODS
  The primary outcome measures determined before data collection were treatment of symptoms and decreased size of fistula.
  
  
  RESULTS
  Seven patients with palatal fistulas were treated with osmotic tissue expanders. Five patients had complete closure of the fistula. Two patients demonstrated slit-like fistulas that were no longer symptomatic and were amenable to closure at time of alveolar bone grafting. No complications were observed.
  
  
  CONCLUSIONS
  The use of osmotic tissue expanders is a viable alternative for repair of large anterior palatal fistulas, especially in a scarred or previously operated palate. Patients were also no longer symptomatic.
authors.forename: Tina F
authors.initials: TF
authors.lastname: Jenq
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Hilliard
authors.forename: Anna A
authors.initials: AA
authors.lastname: Kuang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D016155:Oral Fistula / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D055815:Young Adult