Outcomes of Palatal Fistula Closure with Tongue Flap Using a Parachute Technique

Objective To evaluate the efficacy of tongue flaps in closing large palatal fistulas secondary to cleft palate repair in terms of functionality, esthetics, and donor site morbidity.Design Tertiary academic center.Setting We report our 8-year surgical experience with tongue flaps, with our parachute suture technique in flap inset, and not using tongue fixation methods or feeding tubes.Participants Nineteen patients having recurrent secondary palatal fistula, post-cleft treatment were treated with anteriorly based dorsal tongue flaps.Main outcome measure Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and nasality improvement, donor site morbidity, and esthetics.Results A total of 19 patients in the age range of 1.5 to 34 years were treated with anteriorly based tongue flap. Detachment of the tongue flap was observed in 1 patient. Furthermore, tongue flap necrosis was not observed in any of the patients. Nasal regurgitation was resolved completely in 15 cases (78.9%), and 2 out of 4 failed cases were due to fistula presence in a position out of flap territory. In addition, fistula persists in the case of flap detachment and another case at the location of pedicle division. Speech intelligibility and hypernasality changes were reported as noticeable improvement in 9 (47.4%) and no obvious change in 10 patients (52.6%).Conclusion Using parachute suturing technique can facilitate successful lingual tissue inset in palatal defects with negligible remnant fistula. Moreover, avoiding tongue fixation methods and nasogastric tube-assisted feeding wasn't associated with increased flap dehiscence or suture loosening.