CC BY-NC-ND 4.0 · Indian J Plast Surg 2009; 42(S 01): S123-S128
DOI: 10.1055/s-0039-1699385
Review Article
Association of Plastic Surgeons of India

Oronasal fistula in cleft palate surgery

Partha Sadhu
Global Hospital & Research Centre, Mount Abu, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)


Oronasal fistula (ONF) is the commonest complication associated with cleft palate surgery. The main symptoms associated with ONF are nasal regurgitation of food matter and hypernasality of voice. Repair of cleft palate under tension is considered to be the main reason of ONF though vascular accidents and infection can also be the cause. Most of the ONFs are situated in the hard palate or at the junction of hard and soft palate. Repair of ONF depends on its site, size and mode of presentation. A whole spectrum of surgical procedures starting from small local flaps to microvascular tissue transfers have been employed for closure of ONF. Recurrence rate of ONF is 25% on an average after the first attempt of repair.


  • 1 Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft palate fistulas: A multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg 1991;87:1041-7.
  • 2 Musgrave RH, Bremner JC. Complications of cleft palate surgery. Plast Reconstr Surg 1960;26: 180-9.
  • 3 Kilner TP. Cleft lip and palate repair technique. St Thomas's Hosp Report, 2: 1937. p. 127.
  • 4 Holdsworth WG. Cleft lip and palate. 2 ed. London: William Heinemann Ltd; 1957. p. 145.
  • 5 Phua YS, de Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after palate repair: An audit of 211 children born between 1990 and 2004. Cleft palate Craniofac J 2008;45:172-8.
  • 6 Muzaffar AR, Byrd HS, Rohrich RJ, Johns DF, LeBlanc D, Beran SJ, et al. Incidence of cleft palate fistula: An institutional experience with two stage palate repair. Plast Reconstr Surg 2001;108:1515-8.
  • 7 Diah E, Lo LJ, Yun C, Wang R, Wahyuni LK, Chen YR. Cleft oronasal fistula: A review of treatment results and a surgical management algorithm proposal. Chung Gang Med J 2007;30:529-37.
  • 8 Amaratunga NA. Occurrence of oronasal fistula in operated cleft palate patients: J Oral Maxillofacial Surg 1988;46:834-8.
  • 9 Murrell GL, Requena R, Karakla DW. Occurrence of oronasal fistulas in operated cleft palate patients. Plast Reconstr Surg 2001;107:143-7.
  • 10 Mukherji MM. Cheek flap for short palates. Cleft Palate Craniofac J 1969;6:415-20.
  • 11 Guerrero-Santos J, Altamirano JT. The use of lingual flaps in repair of fistulae of the hard palate. Plast Reconstr Surg 1966;38:123.
  • 12 Jackson IT. Closure of secondary palatal fistulae with intraoral tissue and bone grafting. Brit J Plast Surg 1972;25:73.
  • 13 Agarwal K, Panda K. Management of a detached tongue flap. Plast Reconstr Surg 2007;120:156-6.
  • 14 Pribaz J, Stephens W, Crespo L, Gifford G. A new intraoral flap: Facial artery musculomucosal (FAMM) flap. Plast Reconstr Surg 1992;90:421-9.
  • 15 Chen HC, Ganos DL, Coessens BC, Kyutoku S, Noordhoff MS. Free radial forearm flap for closure of difficult oronasal fistulas in cleft palate patients. Plast Reconstr Surg 1992;90:757-62.
  • 16 Penna V, Bannasch H, Stark GB. The turbinate flap for oronasal fistula closure. Ann Plast Surg 2007;59:679-81.
  • 17 Fallah DM, Baur DA, Ferguson HW, Helman JI. Clinical application of the temporoparietal-galeal flap in closure of a chronic oronasal fistula: review of the anatomy, surgical technique, and report of a case. J Oral Maxillofac Surg 2003;61:1228-30.
  • 18 Losee JE, Smith DM, Afifi AM, Jiang S, Ford M, Vecchione L, et al. A successful algorithm for limiting postoperative fistulae following palatal procedures in the patient with orofacial clefting. Plast Reconstr Surg 2008;122:544-54.