Palatal island flap with or without hinge flap for closure of oroantral or oronasal fistula: A technical note

Objective: The study aimed to introduce the closure technique using palatal island flap with or without hinge flap for oroantral or oronasal fistula. We explained the surgical methods, assessed the efficacy of these techniques and compared with other closure methods. Methods: This study included nine patients who were diagnosed with oroantral or oronasal fistula and underwent treatment; closure technique using palatal island flap with hinge flap (double flap closure) or that without hinge flap (single flap closure) between 2000 and 2022. Etiological factors included malignant tumors, benign tumors, cyst, and trauma. Double flap closure was performed in five cases, wherein primary closure was achieved with hinge flap created using surrounding palatal mucosa and secondary closure was achieved with palatal island flap. Single flap closure was performed in four cases. Results: All nine patients were treated successfully, and follow-up showed no evidence of flap necrosis or major postoperative complications. Conclusions: The main advantages of this double flap closure technique include effective primary closure with hinge flap, which can prevent perforation into the nasal cavity and/or sinus even if the secondary flap (palatal island flap) becomes loose due to palatal mucosa irritation, and rich blood supply in the palatal island flap from the greater palatine artery. These factors confirm the validity of this technique. Secure closure with single palatal island flap was achieved; however, more secure closure can be achieved by using double flap closure technique. Therefore, it is important to choose single or double flap closure technique depending on the case.