“Mucosal Rugosity Unfolding Technique for Closure of Anterior Palatal Fistulae”

ACC 

Introduction: -

Palatal fistulae have been classified by many surgeons in different time periods and the idea behind each classification was to provide good information about the location of the fistula, its size and expected difficulty in the management. Veau, Smith DM, Ohsumi and Richardson (Veau, 1931, Smith DM, 2007, Ohsumi N, 1993 and Richardson S, 2014) have elaborated useful criteria to help and plan the management of palatal fistulae. Fayyaz GQ et al(2019) proposed a new system of classification for palatal fistula based on Location, size & Velopharyngeal functional status of the patient.

Materials & Methods: -

Anterior fistulae in the palate are known complication after palate repair. Anterior fistulae are not always easy to be managed due to paucity of tissues, available for oral layer cover. We usually elevate the tip of the mucoperiosteal flap, before developing the turn in flap for nasal layer closure. The mucosalized undersurface of the mucoperiosteal flap is unfolded & opened up with a sharp blade, thus leading to increase in the length of mucoperiosteal flap. Nasal layer is now developed all around the fistulae. After the nasal layer closure, the lengthened Mucoperiosteal flap provides ample amount of tissue for oral layer cover.

Results: -
Using this technique, we have covered most of the anterior palatal fistulae comfortably and successfully. This approach eliminates the need for more complex procedures such as tongue flap, buccinator flap/s, FAMM flaps, or free flap.


Conclusion: - In selected cases, the Mucosal Rugosity Unfolding Technique offers a single-stage procedure for the closure of challenging anterior palatal fistulae. This technique provides an effective alternative to more complex reconstructive options.

Keywords: - Anterior palatal fistula, Unfolding of the mucosal Rugosity, Lengthened Mucoperiosteal flap.

Craniomaxillofacial/Head and Neck

Plastic Surgery 2023