Oro-Nasal Communication

Abstract

Breach in the palatal vault leading to an abnormal communication between oral and nasal cavity is known as oro-nasal communication. It is an uncommon presentation in day-to-day clinical practice except in some patients of cleft lip and palate.Etiology may be congenital or acquired. Alveolar and palatal cleft defects are the most common etiological factor. The acquired causes may be trauma, periapical pathology, infections, neoplasms, postsurgical complications, and radio and chemo necrosis.Clinical features like nasal regurgitation of food, defective speech, fetid odor, bad taste, and upper respiratory tract and ear infection are associated with oro-nasal communication.Management depends upon the size and site of defect, age of patient, and associated comorbidity. The definitive management is always surgical. Two layered closure provides greater support and stability and reduces the risk of failure. Palatal rotational flaps are suitable for smaller defects. The other local flaps are buccal mucosal flap, tongue flap, and facial artery myomucosal flap. Temporoparietal galeal flap, turbinate flap, free radial forearm flap, and scapular flap have also been successfully used for closure of oronasal communication. Newer procedures like the use of bone morphogenic protein, acellular dermal matrices, human amniotic membrane, and distraction osteogenesis have been tried successfully. The rate of recurrence is high.Unsuccessful surgical attempts and larger defects associated with compromised medical conditions are better managed nonsurgically with obturator incorporating the missing teeth.

Oronasal fistula as a cleft palate sequela : closure with tongue flap. Case report with review of the literature

“…A literature review reveals that the majority of oranasal fistulae in cases of cleft palates are successfully managed by local palatal flaps, but success is limited in more complex situations [1,3,14].…”

“…Since then, the tongue flap has been used in several procedures for the reconstruction of the loss of volume from the intraoral defects, including the repair of oronasal and sinus connections and defects in the base, oral mucosa, lips, tongue, and oropharynx [1,5].…”

“…When the cause has been discovered, it is often a result of trauma, infection, tumors, postoperative iatrogenic side effects, or osteonecrosis [1]. The main etiology of oronasal fistulae remains congenital, associated with cleft palate [1].…”

“…Moreover, in cases requiring multiple surgical procedures, the scarring aspect of the palatal mucosa compromises the efficacy of any flaps used. Other flaps, such as a buccal mucosal flap, a buccal flap, a muscular-mucosal flap on the facial artery, tongue flaps, or even the free micro-braided flaps may be used [1,3]. Their respective indications are discussed in terms of the fistula width and location, and the patient's surgical history, the quality of tissues available, compliance, and dentition [1].…”

“…Nevertheless, the oronasal fistula frequently persists and is found in 15-35% patients after primary closure of the palatovelar slit [3,4]. Such fistulae may cause speech disorders, regurgitation of food in the nasal cavity, bad odors, bad tastes, as well as upper respiratory tract infections [1].…”