SpringerLink
Log in

Use of Conchal Cartilage and Acellular Dermal Matrix in Repair of Palatal Fistulae

  • Living reference work entry
  • Latest version View entry history
  • First Online:
Surgical Atlas of Cleft Palate and Palatal Fistulae

  • 42 Accesses

Abstract

Palatal fistula formation is one of the most unwanted and troublesome complications after cleft palate repair which has many etiologies with an incidence ranging from 4% to 35%. The two main symptoms that are indications for fistula repair are speech disturbance or nasal regurgitation. A third reason is when the fistula will interfere with a needed surgery, such as alveolar bone grafting. There are many options developed to close palatal fistula which all share the concept of creating and closing it in a two-layered fashion, forming nasal and oral layers. Using allograft materials such as acellular dermal matrix and using autogenous materials as Conchal cartilage graft are other methodologies that had been applied for recurrent fistula correction. The upper size limit of palatal fistulas to which this procedure can be applied is about 10 mm in diameter. It is an extremely useful procedure and much simpler method for closure of type I (diameter less than 2 mm) and type II (2 to 5 mm in diameter) fistulas when compared with the previously employed methods. The acellular dermal matrix allografts provide a scaffold for tissue ingrowth, revascularization, and mucosal epithelialization without any evidence of donor-site morbidity or immunologic rejection and the expense of additional surgery time. Utilizing both conchal cartilage and acellular dermal matrix for cleft palate fistula repair as an interposition layer is a safe and simple procedure that reduces fistula recurrence compared with closures using these autogenous materials.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Abdel-Aziz M, Abdel-Nasser W, El-Hoshy H, Hisham A, Khalifa B (2008) Closure of anterior post-palatoplasty fistula using superior lip myomucosal flap. Int J Pediatr Otorhinolaryngol 72:571–574

    Article  Google Scholar 

  • Abdali H, Hadilou M, Feizi A, Omranifard M, Ardakani MR, Emami A (2014) Recurrence rate of repaired hard palate oronasal fistula with Conchal cartilage graft. J Res Med Sci 19(10):956–960

    PubMed  PubMed Central  Google Scholar 

  • Agir H, Eren G, Yasar EK (2015) Acellular dermal matrix use in cleft palate and palatal fistula repair: a potential benefit? J Craniofac Surg 26:1517–1522

    Article  Google Scholar 

  • Ahmed T, Magdy A, Ibrahim A, Moustafa M (2017) Simultaneous repair of cleft lip and palate by vomer flap in complete cleft lip and pa late. EJPMR 4(09):864–869

    Google Scholar 

  • Al-Qattan MM (2001) A modified technique of using the tongue tip for closure of large anterior palatal fistula. Ann Plast Surg 47:458–460

    Article  CAS  Google Scholar 

  • Barone CM, Argamaso RV (1993) Refinements of the tongue flap for closure of difficult palatal fistulas. J Craniofac Surg 4:109–111

    Article  CAS  Google Scholar 

  • Chen H, Ganos DL, Coessens BC et al (1992) Free forearm flap for closure of difficult oronasal fistulas in cleft palate patients. Plast Reconstr Surg 90:757–762

    Article  CAS  Google Scholar 

  • Cohen SR, Kalinowski J, LaRossa D, Randall P (1991) Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management. Plast Reconstr Surg 87:1041–1047

    Article  CAS  Google Scholar 

  • Cole P, Horn TW, Thaller S (2006) The use of decellularized dermal grafting (AlloDerm) in persistent oro-nasal fistulas after tertiary cleft palate repair. J Craniofac Surg 17:636–641

    Article  Google Scholar 

  • Darren M. Smith, Lisa V, Shao J, Matthew F, Frederic W. B., Deleyiannis, Mary AH, Sanjay N, Christine I. Worrall, Jason R. Dudas, Ahmed M. Afifi, Mary L. Marazita, Joseph E. Losee (2007) The Pittsburgh Fistula Classification System: A Standardized Scheme for the Description of Palatal Fistulas. The Cleft Palate-Craniofacial Journal, 44(6): 590–594. First Published Nov 1

    Google Scholar 

  • Diah E, Lo LJ, Yun C, Wang R, Wahyuni LK, Chen YR (2007) Cleft oronasal fistula: a review of treatment results and a surgical management algorithm proposal. Chang Gung Med J 30:529–537

    PubMed  Google Scholar 

  • Ebata K, Ueda M, Shima T, Kaneda T (1988) Transplantation of mucosal tissue model composed of rabbit oral mucosal cells. Artif Organs 6:497–502

    Article  Google Scholar 

  • El-Shazly M (2012) Musculo-nasomucosal unit with complete lateral bony freeing and medial rotation for ideal C-Shape Restoration and Retropositioning of the Levator Veli Palatini. J Craniofac Surg 23(6):1857–1860

    Article  Google Scholar 

  • Fayyaz GQ, Gill NA et al (2019) Pakistan comprehensive fistula classification: a novel scheme and algorithm for Management of Palatal Fistula/dehiscence. Plast Reconstr Surg 143:140e–151e

    Article  CAS  Google Scholar 

  • Futran ND, Haller JR (1999) Considerations for free-flap reconstruction of the hard palate. Arch Otolaryngol Head Neck Surg 125:665–669

    Article  CAS  Google Scholar 

  • Helling ER, Dev VR, Garza J et al (2006) Low fistula rate in palatal clefts closed with the Furlow technique using decellularized dermis. Plast Reconstr Surg 117:2361–2365

    Article  CAS  Google Scholar 

  • Honnebier MB, Johnson DS, Parsa AA, Dorian A, Parsa FD (2000) Closure of palatal fistula with a local mucoperiosteal flap lined with buccal mucosal graft. Cleft Palate Craniofac J 37:127–129

    Article  CAS  Google Scholar 

  • Jeffery SL, Boorman JG, Dive DC (2000) Use of cartilage grafts for closure of cleft palate fistulae. Br J Plast Surg 53:551–554

    Article  CAS  Google Scholar 

  • Kirschner RE, Cabiling DS, Slemp AE et al (2006) Repair of oronasal fistulae with acellular dermal matrices. Plast Reconstr Surg 118:1431–1440

    Article  CAS  Google Scholar 

  • Lehman JA Jr, Curtin P, Haas DG (1978) Closure of anterior palate fistulae. Cleft Palate J 15:33–38

    PubMed  Google Scholar 

  • Losee JE, Smith DM (2011) Acellular dermal matrix in palatoplasty. Aesthet Surg J 31(7 Suppl):108S–115S

    Article  Google Scholar 

  • Matsuo K, Hirose T, Takahashi N et al (1987) Lower eyelid reconstruction with a Conchal cartilage graft. Plast Reconstr Surg 80:547–552

    Article  CAS  Google Scholar 

  • Matsuo K, Kiyono M, Hirose T (1991) A simple technique for closure of a palatal fistula using a Conchal cartilage graft. Plast Reconstr Surg 88:334–337

    Article  CAS  Google Scholar 

  • Muzaffar AR, Byrd HS, Rohrich RJ, Johns DF, LeBlanc D, Beran SJ et al (2001) Incidence of cleft palate fistula: an institutional experience with two-stage palatal repair. Plast Reconstr Surg 108:1515–1518

    Article  CAS  Google Scholar 

  • Noboru O, Onizuka T, Ito Y (1993) Use of a free Conchal cartilage graft for closure of a palatal fistula: an experimental study and clinical application. Plast Reconstr Surg 9:433–440

    Google Scholar 

  • Phua YS, de Chalain T (2008) Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004. Cleft Palate Craniofac J 45:172–178

    Article  Google Scholar 

  • Reid DAC (1962) Fistulae in the hard palate following cleft palate surgery. Br J Plast Surg 15:377–384

    Article  Google Scholar 

  • Richardson S, Hoyt JS, Khosla RK et al (2016) Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study. J Korean Assoc Oral Maxillofac Surg 42(2):77–83

    Article  Google Scholar 

  • Sadove AM, Eppley BL (2006) Cleft lip and palate. In: Grosfeld JL, O’Neill JA, Coran AG, Fonkalsrud EW, Caldamone AA (eds) Pediatric surgery, 6th edn. Mosby Elsevier, Philadelphia, pp 803–812

    Chapter  Google Scholar 

  • Schultz RC (1986) Management and timing of cleft palate fistula repair. Plast Reconstr Surg 78:739–745

    Article  CAS  Google Scholar 

  • Smith DM, Vecchione L, Jiang S et al (2007) The Pittsburgh fistula classification system: a standardized scheme for the description of palatal fistulas. Cleft Palate Craniofac J 44:590–594

    Article  Google Scholar 

  • Steele MH, Seagle MB (2006) Palatal fistula repair using acellular dermal matrix: The University of Florida experience. Ann Plast Surg 56:50–53

    Article  CAS  Google Scholar 

  • Tatsuzo T, Masaki S, Akiko M et al (1992) Assessment of palatal fistula repair using a Conchal cartilage graft, vol. XXVI, Studia Phonologica, pp 42–48

    Google Scholar 

  • Tiwari VK, Sujata S (2006) Orbicularis oris musculomucosal flap for anterior palatal fistula. Indian J Plast Surg 39:148–155

    Article  Google Scholar 

  • Zhang B, Li J, Sarma D, Zhang F, Chen J (2014) The use of heterogeneous acellular dermal matrix in the closure of hard palatal fistula. Int J Pediatr Otorhinolaryngol 78:75–78

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Plastic Surgery Department, Al-Azhar University, Cairo, Egypt

    Ahmed Taha

  2. Plastic Surgery Department, Assiut University, Assiut, Egypt

    Mohamed El-Shazly

  3. Middle East & North Africa, Operation Smile International, Virginia Beach, VA, USA

    Mohamed El-Shazly

  4. Al-Azhar University, Cairo, Egypt

    Yasser Helmy

Authors
  1. Ahmed Taha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed El-Shazly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasser Helmy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed Taha .

Editor information

Editors and Affiliations

  1. Plastic Surgery, Services Institute of Medical Sciences, Lahore, Pakistan

    Ghulam Qadir Fayyaz

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Taha, A., El-Shazly, M., Helmy, Y. (2022). Use of Conchal Cartilage and Acellular Dermal Matrix in Repair of Palatal Fistulae. In: Fayyaz, G.Q. (eds) Surgical Atlas of Cleft Palate and Palatal Fistulae. Springer, Singapore. https://doi.org/10.1007/978-981-15-3889-6_121-2

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-3889-6_121-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-3889-6

  • Online ISBN: 978-981-15-3889-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Use of Conchal Cartilage and Acellular Dermal Matrix in Repair of Palatal Fistulae
    Published:
    31 March 2022

    DOI: https://doi.org/10.1007/978-981-15-3889-6_121-2

  2. Original

    Use of Conchal Cartilage and Acellular Dermal Matrix in Repair of Palatal Fistulae
    Published:
    09 February 2022

    DOI: https://doi.org/10.1007/978-981-15-3889-6_121-1

Search

Navigation