ABSTRACT
Background: Cleft palate repair may be compromised by a number of complications, most commonly
the development of a fistula. Fistulas may cause hypernasal speech, articulation problems
and food or liquid regurgitation from the nose. Objective: The study determines the incidence and management of cleft palatal fistulas in a
series of primary cleft palate repair surgeries. It is a retrospective analysis of
total 185 palatal fistula cases operated at our hospital from the year 2004 to 2016.
Subjects and Methods: Of 185 palatal fistulas, 132 cases had been operated at our institute for primary
palatoplasty, and the rest 53 were the outside-operated cases. The patients with bilateral
as well as unilateral cleft lip and palate were included. Isolated cleft palate patients
were also included in the study. Palatal fistulas were subdivided into three types
depending on their size. Anterior palatal fistulas were mostly treated by using tongue
flap (65.57%), followed by local flaps (34.43%). Middle and posterior palatal fistulas
were mostly treated by von Langenbeck Palatoplasty. One patient (>5 mm fistula) was
treated using free radial forearm flap. Results: Anterior palatal fistulas (65.57%) were most commonly reported, followed by middle
(24.86%) and posterior (9.18%). Most commonly, the size of the fistulas ranged from
2 mm to 5 mm. The complication rate was reported to be 3.75% in case of tongue flap
and 11.9% complications were reported in case of local flaps. Conclusion: Tongue flap remains the flap of choice for managing very difficult and challenging
anterior palatal fistulas compared to local flaps.
KEY WORDS
Cleft palate - palatal fistula - palatoplasty - tongue flap
