La Fistula for Palate Re-repair by Contralateral Mucoperiosteal Flap

This patient was operated for left sided unilateral complete cleft palate but developed a fistula, on the left side in the anterior half of the hard Palate. Palate movements are not good. She is unable to develop good intra oral pressure to produce consonants and has severe nasal air emission. Compensatory articulation errors are more perceptual in speech with severe type of hyper nasality observed. As per Pakistan Comprehensive Fistula Classification, this patient has lateral fistulae La, S3, V2.Plan of Management: For La, S3 & V2, turn-in flaps will be used for nasal layer closure, while oral layer closure will be provided by elevating and advancing the right contralateral mucoperiosteal flap. Palate re-repair with levator dissection and retro-positioning will help to improve the speech.