Abstract
Background
Free flap reconstruction is the standard method for reconstructing large maxillary defects. Palatal fistula is an uncommon complication following reconstructive surgery. This study aims to describe the incidence, etiology, and management of palatal fistulae following reconstruction of oncological maxillectomy defects.
Methods
A total of 108 patients from a single institution who underwent maxillectomy surgery between 2008 and 2014 were retrospectively reviewed. Ninety-two patients had resection of the hard palate. Sixty-eight patients underwent immediate free flap reconstruction of the palate; 55 had reconstruction of the hard palate with skin, and thirteen had reconstruction of the hard palate with muscle.
Results
The incidence of palatal fistulae in the reconstructed palates was 12% (11 patients) in this series: five after muscular reconstruction of the hard palate and six after cutaneous reconstruction. Muscular reconstruction of the hard palate is associated with a significantly higher incidence of palatal fistulae compared with cutaneous reconstruction (p = 0.015). The Cordeiro classification, smoking, diabetes, immunosuppression, and radiotherapy were not significant risk factors (p > 0.05).
Conclusions
Based on our experience, we caution against attempting direct closure for established palatal fistulae, the majority of patients who had attempted direct closure of their fistulae failed to achieve resolution.
Similar content being viewed by others
References
Ng RW, Wei WI (2005) Elimination of palatal fistula after the maxillary swing procedure. Head Neck 27(7):608–612
Anavi Y, Gal G, Silfen R, Calderon S (2003) Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(5):527–534
McCarthy CM, Cordeiro PG (2010) Microvascular reconstruction of oncologic defects of the midface. Plast Reconstr Surg 126(6):1947–1959
Cordeiro PG, Santamaria E (2000) A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 105(7):2331–2346
Futran ND (2001) Retrospective case series of primary and secondary microvascular free tissue transfer reconstruction of midfacial defects. J Prosthet Dent 86(4):369–376
Foster RD, Anthony JP, Singer MI et al (1996) Microsurgical reconstruction of the midface. Arch Surg 131:960–966
Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM (2010) Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 32(7):860–868
Muneuchi G, Miyabe K, Hoshikawa H, Hata Y, Suzuki S, Igawa HH, Mori N (2006) Postoperative complications and long-term prognosis of microsurgical reconstruction after total maxillectomy. Microsurg. 26:171–176
Hardwicke JT, Landini G, Richard BM (2014) Fistula incidence after primary cleft palate repair: a systematic review of the literature. Plast Reconstr Surg 134(4):618e–627e
Fujioka M. Factors predicting total free flap loss after microsurgical reconstruction following the radical ablation of head and neck cancers
Benatar MJ, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Pierre CS, Benezery K, Hechema R, Demard F, Santini J, Bozec A (2013) Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg 66:478–482
Choi S, Schwartz D, Farwell G et al (2004) Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch Otolaryngol Head Neck Surg 130:1308–1312
Lee DH, Kim SY, Nam SY, Choi SH, Choi JW, Roh JL (2011) Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncol 47:528–531
Syme DB, Shayan R, Grinsell D (2012) Muscle-only intra-oral mucosal defect reconstruction. Plast Reconstruct Surg 65(12):1654–1659
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received in relation to the research presented or preparation of the manuscript.
Conflict of interest
Nicholas Tang, Peter Tao, Julian Liew, Tim A Iseli, David Wiesenfeld, Kirstie MacGill, and Anand Ramakrishnan declare that they have no conflict of interest.
Ethical approval
Approval for the study was obtained from the Melbourne Health Human Research Ethics Committee Reference Number 2014193.
Informed consent
Informed consent was regarded as unnecessary in this retrospective study following ethics approval.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tang, N., Tao, P., Liew, J. et al. Palatal fistulas complicating osseomyocutaneous reconstruction of oncological maxillectomy defects. Eur J Plast Surg 42, 577–582 (2019). https://doi.org/10.1007/s00238-019-01533-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-019-01533-x