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Palatal fistula Dr. Hayder H. Hindawi Plastic & reconstructive surgeon Al-Yarmook teaching hospital.

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Presentation on theme: "Palatal fistula Dr. Hayder H. Hindawi Plastic & reconstructive surgeon Al-Yarmook teaching hospital."— Presentation transcript:

1 Palatal fistula Dr. Hayder H. Hindawi Plastic & reconstructive surgeon Al-Yarmook teaching hospital

2 * Fistula is an abnormal communication between oral and nasal cavities lined by epithelial cells. * Heeling by first intention is the goal of the plastic surgeon. * Surgical failure is considered when fistula occurs anywhere along the site of repair. * Fistula is an abnormal communication between oral and nasal cavities lined by epithelial cells. * Heeling by first intention is the goal of the plastic surgeon. * Surgical failure is considered when fistula occurs anywhere along the site of repair. Definition

3 Incidence - After complete unilat. Cleft 7.7%. - After complete bilat. Cleft 12.5% - After incomplete cleft 4.6% - After late closure 35%

4 Classification 1. Etiology … ( congenital ) ( congenital ) ( post traumatic ) ( post traumatic ) ( post inflammatory ) ( post inflammatory ) ( post surgical ) ( post surgical )

5 2. Size … ( Ohsumi-N classification ) : Type I … < 2 mm. Type I … < 2 mm. Type II … 2 – 5 mm. Type II … 2 – 5 mm. Type III … > 5 mm. Type III … > 5 mm. Classification

6 3. Site … ( Converse classification ) : - Anterior ( Alveolar ). - Anterior ( Alveolar ). - Posterior ( Post-alveolar ). - Posterior ( Post-alveolar ). Classification

7 Causes 1. Local factors : - Tension. - Tension. - Hematoma. - Hematoma. - Infection. - Infection. 2. General factors : - Systemic disease. - Systemic disease. - Steroids. - Steroids. - Resp. T. I. - Resp. T. I.

8 Complications 1. Fluid and food escape. 2. Speech defects. 3. Teeth mal-positioning and irregularities. 4. Nasal airway obstruction.

9 Assessment - History & Cl. Examination. - Objective assess. - Imaging … ( lateral cephalometry ) ( video fluroscopy ) ( video fluroscopy ) - Nasoscopy … ( rigid ) ( flexible ).

10 Timing of closure Labio-nasal : - Labio-nasal : - - Small … 2ndry lip surgery - Small … 2ndry lip surgery or alveolar bone graft. or alveolar bone graft. - Large... < school age. - Large... < school age. Palatal : - Palatal : - - Small … ( spontaneous )( delayed ). - Small … ( spontaneous )( delayed ). - Large … closed early. - Large … closed early.

11 Methods of closure * Non-surgical … ( prosthesis ) ( prosthesis ) ( palatal appliance ) ( palatal appliance ) ( Silver Nitrate cauterization ) ( Silver Nitrate cauterization ) * Surgical …

12 Methods of closure * Surgical : * Surgical : 1. Local tissue repair. 1. Local tissue repair. 2. Regional tissue repair. 2. Regional tissue repair. 3. Distal tissue repair. 3. Distal tissue repair. 4. Free tissue transfer. 4. Free tissue transfer.

13 Surgical repair Labio-nasal … Labio-nasal … - Rotation f. - Rotation f. - Advancement f. - Advancement f. Palatal … Palatal …

14 Surgical repair Palatal … Palatal … a – Soft palatal f. a – Soft palatal f. b – Longitudinal f. b – Longitudinal f. c – Transverse f. c – Transverse f. d – Lateral defect f. d – Lateral defect f. e – Round f. e – Round f. f – Slit-like f. f – Slit-like f. g – Large fistula in the anterior aspect of the hard g – Large fistula in the anterior aspect of the hard palate. palate.

15 a – Soft palatal f.

16 b – Longitudinal f.

17 c – Transverse f.

18 e – Round f. Closure of round fistula by lateral rotational or transpositional flap

19 e – Round f. Closure of round fistula by Rintata method

20 f – Slit-like f. Reid method in closing a slit-like fistula Reid method in closing a slit-like fistula

21 f – Slit-like f. Gabka method in closing a slit-like fistuls Gabka method in closing a slit-like fistuls

22 g – Large fistula in the anterior aspect of the hard palate.

23 Regional tissue transfer 1. Tongue : a/ Free composite graft. a/ Free composite graft. b/ Tongue flap. b/ Tongue flap.

24 Regional tissue transfer 2. Cheek. 3. Lip ( buccal flap ). 4. Nasal septum. 5. Pharynx.

25 Distal tissue repair 1. Naso-labial flap. 2. Forehead flap. 3. Neck flap. 4. Arm flap. 5. Little finger flap.

26 Free tissue transfer 1. Free radial forearm flap. 2. Free facial forearm flap.

27 Surgical closure of Oro-nasal fistula by tissue interposition Surgical closure of Oro-nasal fistula by tissue interposition 1. Autogenous bone graft. 2. Cartilage graft ( Choncal )( Ohsumi & Onizuka ). 3. Ossio-integrated implant. 4. Closure using ( Dermal – Fat graft ).

28 Dermal – Fat graft

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40 Cartilage graft

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49 Conclusion PRECLUDES THE NEED 1. THE CONCHAL GRAFT PRECLUDES THE NEED FOR EXTENSIVE LOCAL SURGERY. FOR EXTENSIVE LOCAL SURGERY. 2. MAY ACT AS SUBSTITUE FOR NASAL LINING FLAPS. FLAPS. 3. ACTS AS A THIRD LAYER. 4. FILL THE DEAD SPACE. 5. PREVENTS THE COMUNICATION BETWEEN TWO SUTURE LINES. TWO SUTURE LINES.


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