title: Congenital Palatal Fistula Associated with Submucous Cleft Palate.
abstract: Although cleft lip and cleft palate are among the most common congenital malformations, the presence of an isolated congenital palatal fistula along with a submucous cleft is very rare. This appears as an oval-shaped, full-thickness fenestration in the palatal midline that does not fully extend anteriorly or posteriorly, accompanied by the findings of a submucous cleft. Because of the uncommon nature of this entity, there is controversy about its etiology, diagnosis, and management.
  
  
  METHODS
  Two cases of children with congenital palatal fistulae and a submucous cleft palate are presented who were treated in different settings by different surgeons. Cases are discussed along with a thorough review of the available literature.
  
  
  RESULTS
  Patient 1 presented at 4 years of age with "a hole in the palate" since birth and abnormal speech. His palatal fistula and submucous cleft were repaired with a modified von Langenbeck technique in Ethiopia. At a 2-year follow-up, the palate remained closed, but hypernasal speech persisted. Patient 2 was a 1-year-old presenting with failure to thrive and nasal regurgitation, who underwent a Furlow palatoplasty in the United States with good immediate results. She was unfortunately lost to follow-up.
  
  
  CONCLUSIONS
  A congenital fenestration of the palate is rare. Reports reveal suboptimal speech at follow-up, despite various types of repair, especially when combined with a submucous cleft. Available literature suggests that repair should not focus on fistula closure only but instead on providing adequate palate length to provide good velopharyngeal function, as in any cleft palate repair.
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Mekonen
authors.initials: M
authors.lastname: Eshete
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Liliana
authors.initials: L
authors.lastname: Camison
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Fikre
authors.initials: F
authors.lastname: Abate
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Taye
authors.initials: T
authors.lastname: Hailu
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Demissie
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mohammed
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Azeez
authors.initials: A
authors.lastname: Butali
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: H Wolfgang
authors.initials: HW
authors.lastname: Losken
authors.affiliation: Department of Surgery, Faculty of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.; Burn/Cleft Lip and Palate Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa; and University of North Carolina at Chapel Hill, Chapel Hill, N.C.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Spiess