Buccinator myo-mucosal and mucoperiosteal flap opposite rotation to repair anterior palatal fistula in children

Objective This study sought to investigate the impact of opposite rotation of the buccinator myo-mucosal flap (BMMF) and Mucoperiosteal flap (MPF) in the repair of anterior palatal fistula (APF). Methods A retrospective analysis was conducted on 28 pediatric patients who underwent palatal fistula repair surgery at Nanjing Children’s Hospital from December 2011 to January 2025. The patients were divided into two groups. One group of 18 cases used the opposite rotation of the BMMF and MPF to repair the APF, while the other group of 10 cases used the double flap method to repair the APF. The design of opposite rotation of the BMMF and MPF involved placing the BMMF buccal to the side of the fistula, while the MPF near the fistula was elevated and moved to the mucosa beside the fistula to fill the defect left due to the transfer of the BMMF. Simultaneously, the BMMF was transposed to the palate to repair the APF. Results In all 28 cases, the wounds exhibited successful healing, and the colour of the distal ends of BMMF and MPF appeared normal. The follow-up period was 8 to 12 months. There were 3 cases of bleeding, 5 cases of infection, 4 cases of recurrence, and 3 cases of incision dehiscence. The palatal shape of the children showed satisfactory recovery, and postoperative pronunciation displayed varying degrees of improvement. Conclusion Opposite rotation of BMMF and MPF represents an novel method for repairing APF following cleft palate surgery, demonstrating beneficial clinical outcomes.