Buccinator myomucosal flap with rotational flap in repair of midline and distal palatal Fistulas: A comparative study of 30 cases with speech outcome evaluation

J Craniomaxillofac Surg. 2026 Mar;54(3):104450. doi: 10.1016/j.jcms.2026.104450. Epub 2026 Jan 13.

Abstract

Background: Midline distal palatal fistulas are challenging complications of cleft palate repair, often resulting in velopharyngeal incompetence (VPI) and speech difficulties. This study evaluates the effectiveness of rotational palatal flaps with or without buccinator myo-mucosal flap inclusion in 30 patients.

Methods: A retrospective review of 30 patients treated for midline and distal palatal fistulas was conducted. Group A (n = 15) underwent rotational flaps with buccinator myo-mucosal flap, while Group B (n = 15) underwent flaps without muscle. Outcome measures included fistula closure, VPI improvement, and speech outcomes.

Results: Group A achieved 100 % closure and 87 % speech improvement; Group B had 86.7 % closure and 60 % speech improvement. VPI improvement was significantly higher in Group A.

Conclusion: Incorporation of the buccinator myo-mucosal flap with rotational flaps significantly reduced fistula recurrence and improved speech outcomes in midline distal palatal fistula repair.

Keywords: Buccinator myo-mucosal flap; Midline; Rotational palatal flaps; p distal palatal fistula.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cleft Palate* / surgery
  • Female
  • Humans
  • Male
  • Mouth Mucosa* / surgery
  • Mouth Mucosa* / transplantation
  • Oral Fistula* / etiology
  • Oral Fistula* / surgery
  • Retrospective Studies
  • Speech
  • Surgical Flaps*
  • Treatment Outcome
  • Velopharyngeal Insufficiency / etiology
  • Velopharyngeal Insufficiency / surgery