Oronasal fistula as a cleft palate sequela : closure with tongue flap. Case report with review of the literature

Introduction:  Oronasal fistula have several etiologies. Most of the time, the origin is congenital associated with cleft lip and patate patients, or it can be acquired after trauma, infection, neoplasm, postsurgical complications or radio and chemonecrosis. Excepted for palatal obturators, their treatment is surgical and may use different intraoral flaps. Observation: A 9-year-old girl was sent to consult presenting an oronasal fistula as a sequela of a cleft lip and palate, initially treated in Kosovo (Albania). This was an anterior midpalate fistula, large around 2 cm, functionnaly responsible of a nasal speech and food reflux in the nasal airways. The closure has been done with a tongue flap. Commentary: Most of the oronasal fistulae secondary to a cleft palate are managed with palatal rotational flaps. Nevertheless, they cannot be used in some cases, especially when the fistula size is too large, the localization too anterior and with already scarred palatal tissues around. Then, tongue flap may represent a reliable alternative. Conclusion: The tongue flap allowed a complete closure of the oronasal fistula, with a very good tolerance from the child. It shows its interest into the list of the numerous existing oral flaps. However, considering the discomfort of this technique, it must be done in selected cases, with compliant patients.