Cleft palate fistula repair. Improved results by the addition of bone

The treatment of cleft palate fistulas is currently unstandardized, and the outcome is often unsuccessful. Conventional surgical techniques for the repair of such fistulas involving bony defects have essentially been abandoned by the author. Current protocol calls for their repair in early adolescence (before the age of 10 years) following completion of any required orthodontic expansion of the maxillary dental arch. At the time of fistula repair, all scar tissue is excised between the maxillary segments. Both palatal and gingival soft-tissue flaps are developed to cover either free cancellous bone grafts or free periosteal grafts used to bridge the maxillary defect. This change in technique has resulted in osteogenic filling of the maxillary bony defect and has markedly improved the success rate of fistula repair. Furthermore, it has enhanced the aesthetic correction of the nasal alar base cleft stigmas.