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

A retrospective study of cleft palate repairs showed a 22% fistula incidence. Of these 49% were judged to be symptomatic. Of the fistulae, approximately half required treatment. Of the conventional type surgical closures, there was only a 35% success rate. Conventional methods of surgical repair of anterior hard palate fistulae were seen to result in the very poorest permanent closure. As a result of this study, a new protocol was developed which has resulted in marked improvement in the surgical repair of anterior fistulae. We now close these fistulae in early adolescence following completion of orthodontic expansion using gingival and palatal flaps after the addition of free periosteal grafts or cancellous bone grafts.