Hassan Tahir, Muhammad Imran Khan, Mirza Shehab Afzal Beg
Background: Palatal fistula is the most common complication following cleft palate repair with a reported incidence of 4% to 58%. Ample reconstructive options are described in literature and are in practice. We demonstrate incorporation of Pre-maxillary turn over palatal flap in bilateral cleft palate repair which will aid in reducing rate of anterior palatal fistulas.
Methodology: This was a prospective study conducted at Liaqat National Hospital over a 2-year period (Jan 2019 – Dec 2020). 13 patients planned to undergo bilateral cleft palate repair were included in the study. In all these patients a premaxillary mucoperiosteal turn-over flap was incorporated into the nasal lining. Patients were followed up for 2 years. Early (dehiscence, flap necrosis and fistula formation), and late complications (VPI) were assessed and recorded.
Results: The mean age at the time of intervention was 7.61 months. Eight were males (61%) and 5 were females (38%). There was a partial wound dehiscence of oral lining in one patient, which was most likely secondary to poor oral hygiene as parents were non-compliant to the instructions given. There was no incidence of flap necrosis or fistula formation. None of the patients had VPI at 2 years follow-up.
Conclusion: Incorporation of Pre-maxillary turn over palatal flap for selected bilateral cleft palate repair reduces anterior fistula formation, which is often difficult to close causing hindrance in alveolar cleft closure.
Key Words: Cleft palate, Bardach’s two flap technique, pre-maxillary turn over flap, palatal fistula, muco-periosteal flap