Outcome of buccinator myomucosal flap closure for large palatal fistulas

Objective To retrospectively assess the results of buccinator myo-mucosal flap closure for secondary palatal fistulas in children. Materials and Methods This study was carried out in the department of Pediatric Surgery Pak-Emirates Military Hospital Rawalpindi from 4th Sep 2021 to 15th Nov 2022. All the records of children who were operated on with buccinators myo-mucosal flap were analyzed and were followed up. Their ages, sex, type of fistula, size of defect and buccinator harvest site were noted. Post-operative complications like cheek swelling, difficulty in chewing, flap detachment, flap necrosis and recurrence of fistula were recorded. Data was transferred to statistical package for social sciences-20 (SPSS-20) and analyzed. Results A total of 21 children were operated on during the study period. The age ranged from 2-11years (Mean: 4.5 ±2.11). Thirteen (62%) were female and 8 (38%) were male. Twelve (57%) had previously been operated by Veau’s repair, 7 (33%) had Langenbeck’s repair while only 2 (10%) were operated by Bardach’s two flap techniques. Fourteen (67%) had Pittsburg type-IV, 4 (19%) children had type-III while only 3 (14%) had type-V fistulas. The size of fistula ranged from 0.7 to 2.8cms. Facial swelling was observed in 8 (38%) and chewing difficulty in 7 (33%) cases. The child had to take only liquids during the same period. There was flap detachment in only one (4.8 %) case. There was no flap necrosis, but flap detachment occurred in one (4.8%) child. The flap was divided in all except one case at 2-5 weeks (Mean: 2.7 ±0.9). Conclusion Buccinator myo-mucosal flap can be effectively used for the closure of palatal fistulas with very little donor site morbidity.