M2 and M5 for Palate Re-repair and Pharyngeal Flap

This patient was operated for bilateral complete cleft palate and she developed two midline fistulae; one in the hard palate and another in the soft palate as well as dehiscence of uvula. Intra-oral pressure is very weak to produce consonants and there is moderate nasal air emission. As per Pakistan Comprehensive Fistula Classification, this patient has multiple fistulae MF; M2 & M5, D1 & V3. Plan of Management: For multiple midline fistulae, turn-in flaps will be used for nasal layer closure, while oral layer closure will be provided by elevating and suturing both Mucoperiosteal flaps in the midline. Palate re-repair will close the fistulae and dehiscence of uvula but pharyngeal flap is needed to lengthen the palate and reduce nasal air emission.