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Cleft - Ultimate Treatment

Oro-nasal fistulae and their repair - The ULTIMATE Clinical pearls To achieve the ultimate result various aspects have to be considered. Ignoring one or more of these aspects will lead to suboptimal aesthetic and functional results in oro-nasal fistulae repair. 1. An “oro-nasal fistula” as an incomplete closure in a hP cleft after primary sP cleft surgery, should be called “unrepaired partial hard palate cleft” (hPsP). True oro-nasal fistulae are residues, mainly of unsuccessful hard and/or less soft palate cleft repair. The repair of true oro-nasal fistulae is performed by secondary surgical intervention. 2. As most procedures entail stripping off the palatal mucoperiosteal layer, such secondary repair should only be performed after 2/3 of the facial growth has been completed, after ±9 years of age. Surgery prior to this age leads mostly to midfacial growth disturbance. Therefore, in rare cases, prosthodontic obturator therapy may be indicated up to the age of 9 years. 2. Local flaps are the preferred choice for repair. Only after unsuccessful palatal flap closure, local-pedicled flaps, as buccal fat pad, tongue, temporal muscle, and naso-labial flap, or distant and microvascular flaps should be considered. Distant flap repair is generally reserved for more compromised cleft patients, the so-called non-ultimate repair cases (see chapter 25: ‘cleft syndrome appearances’) and those cases with underlying syndromes, mostly involving the embryological ectodermal component. 4. A large number of different local and distant flap procedures are available. The tongue flaps, anterior-, posterior-, lateral-pedicled or as a rolling flap, are very versatile. Additional rotational flaps can be performed from a tongue flap due to its exceptional blood supply. 5. Very seldom one has to revert to a regional pedicled or a distant microvascular flap to repair oro-nasal fistulae. 248

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Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

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