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Purpose: The most complicated palatal operation is trial of closing large recurrent palatal fistula with previous attempts of closure, because of deficient local tissue which is fibrotic and relatively immobile, repeated surgery may jeopardize blood supply of the palatal tissue. The present study aims at evaluating the outcomes of using an anterior-based tongue flap in closure of recurrent wide palatal fistula. Methods: Fifteen children with wide anterior palatal fistula after previous failed trial for closure using local palatal tissues were included in the study. Patients were managed by anteriorly-based tongue flap to be separated after 2 weeks. Post-operative data were recorded regarding flap viability, recurrence, flap bulk, speech difficulty and tongue disability. Results: The mean age of included patients was 7.5 years. No intraoperative complications were recorded. Taste sensation and swallowing reflex were normal in all patients. Flap dehiscence and fistula recurrence was observed in one patient (6.66%). There was a statistically significant improvement in hypernasality post-operatively (P<0.01). Nasal regurgitation was completely corrected in 13 out of 15 patients (86.66%). Conclusion: Anterior-based tongue flap is an effective alternative technique for closure of wide anterior palatal fistula complicating palatal surgery and is associated with good functional outcome and patient satisfaction.

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