Palatal Fistula Repair Using Acellular Dermal Matrix

Abstract

Palatal fistulas represent a challenging problem for surgeons caring for patients with cleft palate. The purpose of this study was to examine the rate of fistula closure using conventional surgical techniques (Group 1) versus a newer technique (Group 2) employing the use of acellular dermal matrix (AlloDerm). We reviewed the charts of all patients who underwent palatal fistula repair between July 1994 and February 2005. The surgical techniques in Group 1 varied and were considered a historical control. In the second group, a piece of dermal matrix was interposed between the nasal and oral mucoperiosteum after closure of these layers. The primary fistula closure rate for Group 1 was 83.3% (10/12 patients). Fistula closure was obtained in 100% of the patients in Group 2. There were no complications noted other that the failure of the 2 patients in Group 1. The use of AlloDerm in palatal fistula repair has reduced our failure rate from 16.7% to 0%. The use of AlloDerm during palatal fistula repair is safe, effective over time, and has the potential to reduce palatal fistula recurrence rates.

Closure of anterior post-palatoplasty fistula using superior lip myomucosal flap

“…Faced with recurrence, the surgeon's options extend to flaps; tongue flap [6,7], orbicularis oris musculomucosal flap [3], free flaps [8] or grafts; buccal mucosal graft [9], conchal graft [10] and bone graft [11]. A cellular dermal matrix has also been used in palatal fistula repair with good results [12]. When speech disturbance occurs as a result of a fistula of significant size, prosthetic obturation of the fistula (even temporary) can be considered when weighed against repeated failed surgical procedures.…”

Heterogeneous Bovine Acellular Dermal Matrix for Mucosal Repair in Reconstructive Surgery for Laryngeal and Hypopharyngeal Carcinoma

“…However, connective tissue congestion, inflammatory cell infiltration, hemorrhage, and vascular dilation have been reported [5,6,7,8]. Nevertheless, other animal experiments have shown that a heterogeneous ADM repairing mucosa can be completely degraded within 6 months after implantation in the body, leaving no residue, and it does not affect the observation of postoperative recurrence [9,10]. Accordingly, the important role of mucosa implantation in early tissue healing is confirmed, where it prevents the ingrowth of fibrous connective tissue, guides the structural arrangement of fibroblasts and new collagen, reduces scar formation and provides a protective barrier for epithelial cell migration and colonization, thereby enabling epithelial cell repair without inflammatory cell interference [7,11].…”

Cleft Lip and Palate

“…20 One concern raised with this technique is the increased rates of oronasal fistulas. 76 Only anecdotal evidence is available for the use of acellular dermis placed between the oral and nasal flaps to decrease in fistula rates 77,78 (Level IV evidence).…”