Outcomes of Facial Artery Musculomucosal Flap in Repair of Post-palatoplasty Fistula - A Retrospective Study.

Introduction: Closure of palatal fistula is difficult due to excessive scarring of the palate after previous surgery. The facial artery musculomucosal (FAMM) flap is considered a better option for palatal fistula closure due to its axial blood supply and minimal donor site morbidity. The aim of this study was to evaluate the results of harvesting FAMM flap for closure of medium and large palatal fistulas in terms of its versatility, reliability, feeding and speech assessment. Materials and Methods: A retrospective analysis was performed on patients with post-palatoplasty fistula admitted to the outpatient clinics of the Department of Plastic Surgery and the Department of Maxillofacial Surgery of Assiut University Hospital from March 2022 to February 2024. Results: Twenty patients aged 3-11 years, with female:male = 3:2 ratio, were included in the study. Two flaps experienced venous congestion and then partial flap necrosis. In addition, two flaps had wound dehiscence with mild infection. One patient experienced complete flap loss and then a late recurrent fistula. Most patients were able to feed well, except one patient was unable to swallow and had nasal regurgitation of fluids, that was relieved after second surgery by dorsally based tongue flap. Most patients had intelligible speech during verbal communication, only one patient had nasal tone and hypernasality and two patients were unable to communicate verbally. Conclusion: The FAMM flap is suitable for closing medium and large fistulas due to its versatility and vascular reliability. It has fewer complications and sufficient functional and aesthetic results.