الفهرس 
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Abstract
Oronasal fistulae in the soft palate may be small and do not require early correction if speech is satisfactory. If bone grafting is performed during the stage of mixed dentition, these fistulae can be closed then. Moderate sized and large fistula of the soft Palate may be repaired by relaxing incisions and a two-layer closure.
In naso-labial and oro-nasal fistula, an incision is made around the fistula to create flaps for nasal closure.
Any hypertrophic mucosa is resected, failure to do this will impede healing. One or two muco-periosteal flaps are elevated from the palate and are approximated to achieve oral closure.
Larger fistula or those extending into the buccal sulcus necessitate gingival flaps for closure. In large defects, especially bilateral ones, buccal flaps may be necessary to achieve secure closure.
The alveolar cleft and the space between the flaps are packed with autogenous cancellous bone graft. Particular care must be taken with the buccal flap to suture its base high in the buccal sulcus, otherwise, the buccal sulcus is obliterated, making it extremely difficult to fit a prosthesis or a removable bridge, If possible, gingival flaps are used.
However, in the case of large fistula, only buccal mucosa provides a flap of sufficient size to ensure secure closure.
Palatal Fistula located posterior to the alveolus may vary in size from 2 mm to greater than 10 mm. Frequently there have been prior attempts at closure, resulting in considerable muco¬periosteal scarring. In the majority of cases closure can be obtained by using local Palatal flaps. In rare cases distant flaps are indicated.
Tongue flaps is useful in end stage palatal fistulae secondary to cleft palate.
Buccinator Myomucosal Flap is an axial pattern flap that is suitable in reconstruction of medium sized oral soft tissue defects as they are rich in blood supply.
Facial artery musculomucosal flap is an alternative for closing the scarred, while recurrent fistula.
The Nasal Artery Musculomucosal Cutaneous (NAMMC) Flap in difficult palatal fistula closure as a new modification of facial artery composite flap.
Orbicularis Oris Musculomucosal Flap for Anterior Palatal Fistula is a better alternative to local palatal tissue for repair of these fistulae. It is a safer flap because of its well-defined blood supply.
Treatment of palatal fistula by expansion can be done when there is not enough tissue to repair the defect.
Simultaneous Cortex Bone Plate Graft with Particulate Marrow and Cancellous Bone for closure of palatal fistulae to increase the rate of success.