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International Bulletin of Otorhinolaryngology

Surgical closure of oronasal communications

R. Yotsova, Ts. Gerova

Abstract

Background: An oronasal communication (ONC) is a pathological opening between the oral and nasal cavities, normally separated by the hard and soft palate. The integrity of the palate is essential for the physiological acts of respiration, mastication, digestion, and phonetics. The persistence of ONC or its unsuccessful closure leads to a permanent communication between the cavities, called an oronasal fistula (ONF). The most common reason for a congenital ONC/ONF is cleft defects, while for acquired ONC/ONF are trauma, tumors, and iatrogenic causes. The main symptoms of ONC/ONF include liquid regurgitation and leakage through the nose, rhinitis, speech disorders, halitosis, and persistent and recurrent respiratory and ear infections.
Aim: This review aims to summarize and compare the treatment methods for surgical closure of ONC/ONF, define and point out their advantages and limitations, and give recommendations for further research.
Material and methods: An electronic search was performed via four electronic databases: Pubmed, Scopus, Web of Science, and Google Scholar and using the following keywords: (((oronasal) OR (oro-nasal)) AND ((communication) OR (fistula)) AND ((cleft) AND (palate))). After analysis of the obtained data, 28 articles were included in this review.
Results and discussion: Different soft-tissue flaps and their modifications have been proposed to provide secure closure with minimum post-operative complications and bone deformities. Local flaps, if available, are preferred over distant soft tissue flaps. Some novel techniques utilize various grafts and tissue regeneration materials, such as acellular dermal matrix, bone morphogenic proteins, collagen, human amniotic membrane, etc.
Conclusion: Various methods for ONC/ONF closure have been suggested over the years. The surgical management aims to provide a soft-tissue barrier between the oral and nasal cavities and, thus, restore their anatomical integrity and functions. The factors that should be considered before the surgery are etiology, location, size of the communication, quality and quantity of the surrounding soft tissues in the area, age of the patient, and comorbidities.

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DOI: http://dx.doi.org/10.14748/orl.v20i1.10015

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