European Journal of Plastic Surgery

, Volume 42, Issue 6, pp 577–582 | Cite as

Palatal fistulas complicating osseomyocutaneous reconstruction of oncological maxillectomy defects

  • Nicholas TangEmail author
  • Peter Tao
  • Julian Liew
  • Tim A. Iseli
  • David Wiesenfeld
  • Kirstie MacGill
  • Anand Ramakrishnan
Original Paper



Free flap reconstruction is the standard method for reconstructing large maxillary defects. Palatal fistula is an uncommon complication following reconstructive surgery. This study aims to describe the incidence, etiology, and management of palatal fistulae following reconstruction of oncological maxillectomy defects.


A total of 108 patients from a single institution who underwent maxillectomy surgery between 2008 and 2014 were retrospectively reviewed. Ninety-two patients had resection of the hard palate. Sixty-eight patients underwent immediate free flap reconstruction of the palate; 55 had reconstruction of the hard palate with skin, and thirteen had reconstruction of the hard palate with muscle.


The incidence of palatal fistulae in the reconstructed palates was 12% (11 patients) in this series: five after muscular reconstruction of the hard palate and six after cutaneous reconstruction. Muscular reconstruction of the hard palate is associated with a significantly higher incidence of palatal fistulae compared with cutaneous reconstruction (p = 0.015). The Cordeiro classification, smoking, diabetes, immunosuppression, and radiotherapy were not significant risk factors (p > 0.05).


Based on our experience, we caution against attempting direct closure for established palatal fistulae, the majority of patients who had attempted direct closure of their fistulae failed to achieve resolution.


Maxillectomy Head and neck oncology Palatal fistulae Oroantral fistulae 


Compliance with ethical standards


No funding was received in relation to the research presented or preparation of the manuscript.

Conflict of interest

Nicholas Tang, Peter Tao, Julian Liew, Tim A Iseli, David Wiesenfeld, Kirstie MacGill, and Anand Ramakrishnan declare that they have no conflict of interest.

Ethical approval

Approval for the study was obtained from the Melbourne Health Human Research Ethics Committee Reference Number 2014193.

Informed consent

Informed consent was regarded as unnecessary in this retrospective study following ethics approval.


  1. 1.
    Ng RW, Wei WI (2005) Elimination of palatal fistula after the maxillary swing procedure. Head Neck 27(7):608–612CrossRefGoogle Scholar
  2. 2.
    Anavi Y, Gal G, Silfen R, Calderon S (2003) Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(5):527–534CrossRefGoogle Scholar
  3. 3.
    McCarthy CM, Cordeiro PG (2010) Microvascular reconstruction of oncologic defects of the midface. Plast Reconstr Surg 126(6):1947–1959CrossRefGoogle Scholar
  4. 4.
    Cordeiro PG, Santamaria E (2000) A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg 105(7):2331–2346CrossRefGoogle Scholar
  5. 5.
    Futran ND (2001) Retrospective case series of primary and secondary microvascular free tissue transfer reconstruction of midfacial defects. J Prosthet Dent 86(4):369–376CrossRefGoogle Scholar
  6. 6.
    Foster RD, Anthony JP, Singer MI et al (1996) Microsurgical reconstruction of the midface. Arch Surg 131:960–966CrossRefGoogle Scholar
  7. 7.
    Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM (2010) Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 32(7):860–868PubMedGoogle Scholar
  8. 8.
    Muneuchi G, Miyabe K, Hoshikawa H, Hata Y, Suzuki S, Igawa HH, Mori N (2006) Postoperative complications and long-term prognosis of microsurgical reconstruction after total maxillectomy. Microsurg. 26:171–176CrossRefGoogle Scholar
  9. 9.
    Hardwicke JT, Landini G, Richard BM (2014) Fistula incidence after primary cleft palate repair: a systematic review of the literature. Plast Reconstr Surg 134(4):618e–627eCrossRefGoogle Scholar
  10. 10.
    Fujioka M. Factors predicting total free flap loss after microsurgical reconstruction following the radical ablation of head and neck cancersGoogle Scholar
  11. 11.
    Benatar MJ, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Pierre CS, Benezery K, Hechema R, Demard F, Santini J, Bozec A (2013) Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg 66:478–482CrossRefGoogle Scholar
  12. 12.
    Choi S, Schwartz D, Farwell G et al (2004) Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch Otolaryngol Head Neck Surg 130:1308–1312CrossRefGoogle Scholar
  13. 13.
    Lee DH, Kim SY, Nam SY, Choi SH, Choi JW, Roh JL (2011) Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncol 47:528–531CrossRefGoogle Scholar
  14. 14.
    Syme DB, Shayan R, Grinsell D (2012) Muscle-only intra-oral mucosal defect reconstruction. Plast Reconstruct Surg 65(12):1654–1659Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nicholas Tang
    • 1
    Email author
  • Peter Tao
    • 2
  • Julian Liew
    • 1
  • Tim A. Iseli
    • 2
  • David Wiesenfeld
    • 3
  • Kirstie MacGill
    • 1
  • Anand Ramakrishnan
    • 1
  1. 1.Department of Plastic & Reconstructive SurgeryThe Royal Melbourne HospitalParkvilleAustralia
  2. 2.Department of Otolaryngology, Head & Neck Surgery, Nose and Throat SurgeryThe Royal Melbourne HospitalParkvilleAustralia
  3. 3.Department of Oral and Maxillofacial SurgeryThe Royal Melbourne HospitalParkvilleAustralia

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