Daiem Muhammad, Gill Nauman Ahmad, Jan Sadia Nosheen, Turk Marvee, Ganatra Muhammad Ashraf, Bashir Muhammad Mustehsan, Low David, Breugem Corstiaan, Chou Pang-Yun, Fayyaz Ghulam Qadir
From the Department of Plastic Surgery, CLAPP Hospital, Lahore, Pakistan.
Department of Plastic Surgery, Operation Smile Incorporated, Virginia Beach, VA.
Plast Reconstr Surg Glob Open. 2025 Aug 4;13(8):e6987. doi: 10.1097/GOX.0000000000006987. eCollection 2025 Aug.
Palatal fistulae are a well-known complication after palatoplasty. In particular, anterior palatal fistulae (APF) pose a challenge for even the most experienced surgeons. In this study, we present a novel technique for APF repair that leverages the unfurling of epithelialized mucosal folds to lengthen palatal mucoperiosteal flaps so they reach the anterior palate without other complex maneuvers.
We conducted a retrospective review of patients with APF who presented to a cleft center in Lahore, Pakistan, between 2015 and 2020. Patients without mucosal rugosities on examination were excluded. Data collection included demographic characteristics, physical examination, operative management, and postoperative outcomes. Statistical analyses were conducted using SPSS.
A total of 30 patients with APF were treated using this technique. Patients had an average age at presentation of 11 years (range 3-25 y), with 17 (56.7%) men and 13 (43.3%) women. The average length gained in mucoperiosteal flaps was 12.57 mm on the left and 9.73 mm on the right. Five (16.7%) patients experienced fistula recurrence. Furthermore, 7 (23.3%) patients underwent a concomitant pharyngeal flap for insufficient palatal length at presentation, whereas 6 (20%) were scheduled for one later.
Our study offered a promising single-stage solution for APF closure without donor-site morbidity. Further validation across centers is required to establish this technique as a standard of treatment for APF. However, the presence of a mucosal rugosity is a prerequisite for this technique.
腭裂瘘是腭裂修复术后一种众所周知的并发症。尤其是前腭裂瘘（APF），即使对最有经验的外科医生来说也是一项挑战。在本研究中，我们提出了一种修复APF的新技术，该技术利用上皮化黏膜皱襞的展开来延长腭黏骨膜瓣，使其无需其他复杂操作即可到达前腭部。
我们对2015年至2020年间在巴基斯坦拉合尔一家腭裂中心就诊的APF患者进行了回顾性研究。检查时无黏膜皱襞的患者被排除。数据收集包括人口统计学特征、体格检查、手术管理和术后结果。使用SPSS进行统计分析。
共有30例APF患者采用该技术进行治疗。患者就诊时的平均年龄为11岁（范围3 - 25岁），其中男性17例（56.7%），女性13例（43.3%）。黏骨膜瓣左侧平均延长长度为12.57毫米，右侧为9.73毫米。5例（16.7%）患者出现瘘管复发。此外，7例（23.3%）患者因就诊时腭长度不足同时进行了咽瓣手术，而6例（20%）患者随后计划进行该手术。
我们的研究为APF闭合提供了一种有前景的单阶段解决方案，且无供区并发症。需要跨中心进一步验证，以将该技术确立为APF的治疗标准。然而，存在黏膜皱襞是该技术的一个前提条件。
