OBJECTIVE: Secondary palatal fistulae represent a reconstructive challenge to restore palatal competence, phonation and ingestion. We present our experience with facial artery musculomucosal (FAMM) flap reconstruction of difficult secondary palatal fistulae that may otherwise have required free flap reconstruction.

METHODS: We retrospectively evaluated 18 consecutive patients who underwent palatal reconstruction with FAMM flaps between 2000 and 2003. The patients ranged in age from 2-24 years at the time of surgery (mean=10.6 years). The post-operative follow-up ranged from 2 to 30 months (mean=6 months) during which patients were evaluated for closure of palatal fistulae.

RESULTS: A total of 21 flaps were performed in 18 patients for palatal defects ranging from 1.5 cm2 to 11 cm2 (mean 5.1 cm2). All flaps were inferiorly based (antegrade flow) and 3 patients required bilateral FAMM flaps. All 18 patients achieved closure of their fistula at the initial operation without donor morbidity. There were no recurrences of oronasal fistulae during the 30 month follow-up period.

CONCLUSION: We share our clinical experience with FAMM flap reconstruction of difficult secondary palatal fistulae. Our experience suggests that FAMM flaps provide well-vascularized durable soft tissue closure of palatal fistula without recurrence over a three year period of follow up.