Oronasal fistula occurs as a result of breakdown of primary cleft palate repair. Large palatal fistulas are a challenging problem. Presented here is a man who reported to us with a large palatal fistula. He had undergone cleft palate repair elsewhere several years back but the flap dehiscence had failed. Now the local tissue was inadequate for fistula closure, therefore a tongue flap was indicated. The versatility of the tongue flap lies in their excellent vascularity, availability of large amounts of tissue, relative ease of technique, adjacent tissue and no scar formation.
The surgical plan was to use an anteriorly based tongue flap. An incision was made around the margins of the fistula. Mucosa was mobilized and the nasal lining reconstructed. An anteriorly based flap was designed on the tongue, based on the size of the defect and based on the anterior branch of the lingual artery while including 2-3 mm of muscle thickness to allow for adequate vascularization. The flap was raised from the dorsum of the tongue, sutured to the raw edges of the palatal defect and donor site closed. The flap was left in place for 3 weeks after which the pedicle was divided. Complete healing was obtained and the patient does not have any residual fistula.
