Fox Carly M, McKenzie Jo-Lyn C, Morris Helen C, Phua Yun S, Bade Stuart A, Bowman James, Theile Richard J
From the Departments of Plastic and Reconstructive Surgery.
Otolaryngology/Head and Neck Surgery.
Plast Reconstr Surg. 2023 Mar 1;151(3):629-633. doi: 10.1097/PRS.0000000000009927. Epub 2022 Nov 22.
Large or multiply recurrent oronasal fistulas following cleft palate repair present a challenging problem. Nasal septal mucoperichondrial flaps have been widely used for repair of skull base defects; however, their use in the repair of oronasal cleft palate fistulas has not previously been described. In this pilot study, the authors describe anterior palatal fistula repair using a nasal septal flap and review their experience with this technique over 4 years. Fourteen patients with anterior palatal fistulas not amenable to repair using local palatal flaps were included for analysis. The mean size of the fistula was 12 mm in maximum dimension. Flap healing with complete or near-complete closure of fistula was achieved in 13 patients (93%). Five of these patients had a small, slit-like residual fistula that was asymptomatic. Nasal septal flaps are a new technique for repair of large or recurrent palatal fistulas. The procedure is well-tolerated with minimal side effects, high success rate, and low incidence of recurrence.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
腭裂修复术后出现的大型或多处复发性口鼻瘘是一个具有挑战性的问题。鼻中隔黏骨膜瓣已广泛用于颅底缺损的修复；然而，此前尚未描述其在口鼻腭裂瘘修复中的应用。在这项前瞻性研究中，作者描述了使用鼻中隔瓣修复腭前瘘，并回顾了他们在4年中使用该技术的经验。纳入14例无法使用局部腭瓣修复的腭前瘘患者进行分析。瘘管的平均最大尺寸为12毫米。13例患者（93%）实现了皮瓣愈合，瘘管完全或接近完全闭合。其中5例患者有一个小的、裂缝状的无症状残余瘘管。鼻中隔瓣是修复大型或复发性腭瘘的一种新技术。该手术耐受性良好，副作用最小，成功率高，复发率低。
临床问题/证据水平：治疗性，IV级。
