Objective: Oronasal ﬁstula represents a functional problem, as it may result in nasal regurgitation of food and
ﬂuids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high
recurrence rate. The aim of this study was to assess the eﬃcacy of closure of hard palate ﬁstula by two layers of
Methods: Eighteen patients with ﬁstula of the hard palate were included. The ﬁstula was repaired by two layers
of mucoperiosteal ﬂaps; the ﬁrst layer was created from the mucoperiosteum surrounding the ﬁstula as bilateral
hinge ﬂaps and the second layer was formed of a rotational ﬂap based on the greater palatine artery. Pre- and
postoperative clinical assessment was performed.
Results: The etiology of ﬁstulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3
patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal
regurgitation and hypernasal speech. Complete closure of all ﬁstulas was achieved at ﬁrst attempt, with no
recurrence through the follow up period.
Conclusions: Closure of oronasal ﬁstula by two layers of mucoperiosteal ﬂaps is an eﬀective method and it has
neither complications nor recurrence.