A palatal fistula that occurs after cleft palate surgery should be considered for treatment to address the problems of oral sanitization, articulation, and feeding. Many procedures for a palatal fistula have been reported to date. There are often difficulties with surgery in closing a palatal fistula, such as the existence of severe scar tissue surrounding the fistula, insufficient tissue to close it, and difficulties in maneuvering for the surgeon. We had an opportunity to treat an elderly patient who had undergone cheiloplasty and palatoplasty for bilateral cheilognathopalatoschsis in childhood but who had an untreated alveolar cleft and a palatal fistula that had opened after the surgery. We performed palatal fistula closure to both the nasal cavity side and the intraoral aspect, using bilateral nasolabial flaps. After surgery, the patient did not have a reoccurrence of the palatal fistula; neither did he have flow of food into the nasal cavity, hypernasality, or sialorrhea. The donor site scar was inconspicuous with a cosmetically good appearance. Nasolabial flaps have not generally been used for palatal fistula closure after cleft palate surgery, because a scar remains at the donor site on the face. However, we think this technique is useful. It has the advantage of a stable blood supply and can acquire a flap of adequate size to treat an intractable palatal fistula.
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