Labial Flap for Anterior Palatal Fistula Closure

Abstract

Background Anterior palatal fistula is a common and troublesome complication following cleft palate repair. Patients often present with nasal regurgitation and speech disturbances, which significantly affect function and quality of life. Closure is difficult, particularly in cases with fibrosis, scarring, or inadequate local tissue after multiple failed repairs. Conventional palatal flaps are often unreliable in such settings, necessitating alternative methods. The labial flap has been proposed as a reliable option for these complex cases.

Introduction The labial flap is a mucomuscular flap based on the free border of the upper lip. It is tunneled through the alveolar cleft to close the oral layer of the fistula and typically requires a staged approach, with flap division and inset at around three weeks.

Methodology A prospective series of 35 patients with anterior palatal fistula and a history of failed previous closure was managed using the labial flap. Patient demographics, fistula characteristics, surgical details, and postoperative outcomes were recorded. The primary endpoint was successful fistula closure. Secondary outcomes included donor site morbidity and functional recovery.

Results Complete closure was achieved in 28 of 35 patients (80%). Wider fistulas and cases with severe scarring had relatively higher recurrence. Donor site morbidity was minimal, and patients reported less discomfort and fewer functional restrictions compared with those undergoing tongue or buccinator flaps.

Conclusion The labial flap is a dependable and tissue-sparing technique for anterior palatal fistula closure, especially in patients with compromised palatal tissue or repeated failed repairs. It provides a high success rate, low morbidity, and ease of execution, making it a valuable addition to the reconstructive options in cleft palate surgery.

Keywords: anterior palatal fistula, labial flap, cleft palate complication, fistula closure, donor morbidity

Publication History

Article published online:
10 November 2025