This is a 5-year-old female patient referred to our service under the diagnosis of oronasal fistula.
Among his antecedents we found that he underwent bilateral cheiloplasty and palatoplasty of the soft palate at the age of 6 months and palatoplasty of the hard palate at 4 years, presenting in this last procedure nasal reflux causing nasal reflux.
Intraoral examination revealed an oronasal fistula at the junction of the primary and secondary palate on the left side of approximately 12 mm x 25 mm.
1.
It was planned to close the fistula with a lingual flap of anterior base due to the size of the defect.
Technique
Under general anesthesia, a nasotracheal intubation was performed, closing the palatal defect with a tissue margin of approximately 8mm.
The mucosa revolving around the fistula was unfolded and its borders were facing to create a nasal floor.
An aluminum template was made with the dimensions of the fistula, with which a slightly larger flap was designed.
The lateral edges of the tongue are sutured to an acrylic plate in the form of a bandage, which has the function of stabilizing and supporting the tongue to facilitate the flap.
1.
Once the lingual flap is obtained, primary closure of the open lingual area is performed.
Subsequently, the flap is postponed over the oronasal fistula and the suture starts starting from behind forward.
1.
Twenty-one days after surgery an perfusion test was performed, no ischemia data were observed, so the local anesthesia was eliminated.
Successful closure of the fistula was achieved, presenting a small anomaly in the immediate postoperative period, which had a spontaneous closure at three months.
