Acellular dermal matrix allograft: An effective adjunct to oronasal fistula repair in patients with cleft palate

CONTEXT: Oronasal fistula (ONF) following cleft palate (CP) repair are a challenging problem associated with high recurrent rates. Acellular dermal matrix allograft is an available tissue substitute. AIMS: The aim of this study was to evaluate the effectiveness of acellular dermal matrix in the repair of ONF associated with CP that is recurrent or larger than 15 mm in any dimension. SETTINGS AND DESIGN: This is a prospective study where 12 patients with repaired CP suffering from ONF of the hard palate >15 mm in diameter were included. MATERIALS AND METHODS: Age ranged from 12 to 25 years. Acellular dermal matrix was firmly secured between repaired oral and nasal mucosal layers. Patients were clinically followed-up for 6 months postoperatively to assess total time for complete healing, dehiscence and/or refistulaization. STATISTICAL ANALYSIS USED: Fisher's exact test. RESULTS: Acellular dermal matrix was integrated with successful fistula closure in all except 1 patient where failure of graft integration was noticed early postoperatively. In 6 patients, the oral mucosal layer showed dehiscence, through which the graft was exposed. Graft integration extended from 4 to 12 weeks postoperatively during which patients were instructed to follow a soft diet and meticulous oral hygiene measures. CONCLUSIONS: Acellular dermal matrix allografts are safe and effective adjuncts for use in closure of ONF in the hard palate that is recurrent or larger than 15 mm in any dimension.