Publication date: Available online 22 May 2019
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rafael Denadai, Hyung Joon Seo, Lun-Jou Lo
Abstract
Background
The anterior oronasal fistulae neighboring the alveolar cleft could persist or reappear after the alveolar reconstruction with cancellous bone grafting. The persistent symptomatic anterior oronasal fistulae need to be repaired, but the surgery remains a challenge in cleft care. Surprisingly, this issue has rarely been reported in the literature. The purpose of this long-term study was to report a single surgeon experience with a therapeutic protocol for persistent symptomatic anterior oronasal fistula repair.
Methods
This is a retrospective study of consecutive patients with Veau type III and IV clefts and persistent symptomatic anterior oronasal fistulae managed according to a therapeutic protocol from 1997 to 2018. Based on fistula size, patients were treated with local flaps associated with an inter-positional graft or two-stage tongue flaps (small/medium or large fistulae, respectively). The surgical outcomes were classified as “good” (complete fistula closure with no symptoms), “fair” (asymptomatic narrow fistula remained), or “poor” (failure with persistent symptoms).
Results
Forty-four patients with persistent symptomatic anterior oronasal fistulae were reconstructed with local flaps associated with inter-positional fascia or dermal fat grafting (52.3 percent) or two-stage tongue flaps (47.7 percent). Most of patients (93.2 percent) presented “good” outcomes, ranging from 87 to 100 percent (local and tongue flaps, respectively). Three (6.8 percent) patients presented symptomatic residual fistula (“poor” outcomes).
Conclusions
For the repair of persistent symptomatic anterior oronasal fistulae, this therapeutic protocol provided satisfactory outcome with low fistula recurrence rate.
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