Novel Use of Osmotic Tissue Expanders to Treat Difficult Anterior Palatal Fistulas

Abstract

Objective

Novel use of osmotic tissue expanders to recruit local palatal mucoperiosteum for the treatment of difficult anterior palatal fistulas.

Design

This is a retrospective review of our experience with osmotic tissue expanders for closure of secondary palatal fistulas.

Setting

The study occurred at Oregon Health and Science University, a tertiary care level academic hospital.

Patients, Participants

All patients were treated for combined cleft lip and palate by the Oregon Health and Science University Craniofacial Disorders multidisciplinary team. They were determined to be appropriate candidates due to the anterior location of the fistula and symptomatic nature. Patients complained of significant nasal regurgitation of liquid and solids.

Interventions

All patients underwent a two-stage procedure under general anesthesia. The first stage was placement of the expanders. The second stage was 1 week later, with removal of the expanders, palatal revision, and closure of the oronasal fistula.

Main Outcome Measure

The primary outcome measures determined before data collection were treatment of symptoms and decreased size of fistula.

Results

Seven patients with palatal fistulas were treated with osmotic tissue expanders. Five patients had complete closure of the fistula. Two patients demonstrated slit-like fistulas that were no longer symptomatic and were amenable to closure at time of alveolar bone grafting. No complications were observed.

Conclusions

The use of osmotic tissue expanders is a viable alternative for repair of large anterior palatal fistulas, especially in a scarred or previously operated palate. Patients were also no longer symptomatic.