RECURRENT PALATAL FISTULA AND NASAL REGURGITATION;

Anteriorly based dorsal tongue flap: A reliable solution.

Abstract

Background: Post Palatoplasty fistulas are the common complications seen after cleft palate repair. This produce various
symptoms including regurgitation of fluids into nasal cavity, interference with normal speech and middle ear problems . Although small
fistulas can be successfully treated with local flaps such as palatal or buccal mucosal flaps, large fistulas are difficult to treat. Because of
rich blood supply, tongue is a suitable and convenient source of large flap. The anteriorly based dorsal tongue flap is a safe and effective
method for closure of relatively large recurrent palatal fistula without any functional impairment of donor site. Objective: To determine the
success rate of Tongue flap in correction of the nasal regurgitation in recurrent palatal fistulas Duration of study: 12 months from 16th
July 2010 to 15th July 2011. Study design: It was descriptive case series. Settings: This study was carried out in the department of
plastic surgery Services institute of medical sciences, Services Hospital Lahore. Methods: Forty patients who were having recurrent
palatal fistula included in this study. All underwent palatal fistula repair by dorsal tongue flap. Each patient was followed after one month of
operation for fistula closure and correction of nasal regurgitation. Results: In this study 65 percent of the patients were male, while 35
percent of them were female. 21 (52.5%) of the patients belonged to age group 10-15 years, while 14 (35.0%) of the respondents had 16-
20 years of age and remaining 5 (12.5%) of them had 21-30 years of age. The 90 percent (out of 40) of the patients had complete fistula
closure, while only 10.0 percent of them had not complete fistula closure. Nasal regurgitation was corrected in 38 (95 %) of the patients
and remaining 2 ( 5%) patients had un-corrected nasal regurgitation. Conclusions: Tongue flap is a effective and reliable method of
treatment, not only for palatal fistula closure but also treating nasal regurgitation which is a social stigma for patients in recalcitrant palatal
fistula.