Reconstruction of a Moderate Palatal Fistula and Facial Contour in a 61-Year-Old Patient After Cleft Lip and Palate Surgery Using a Free Latissimus Dorsi Muscle Flap Combined With the Scapular Bone

A 61-year-old female patient with cleft lip and palate presented with a moderate palatal fistula and associated nasal deformity. The defect posed a surgical challenge, being too extensive for local mucosal flap closure, yet too confined to permit standard free flap insertion. Due to the restricted intraoral working space and reduced mucosal vascularity, a latissimus dorsi free muscle flap combined with the scapular bone was chosen for reconstruction. The nasal side of the fistula was closed using a hinge flap, and mucosalization of the muscle occurred spontaneously within 1 month. This novel technique successfully restored the continuity of the maxillary arch, addressed the alar base depression, and provided stable support for dentures. No recurrence was observed during the 1-year follow-up period. This case highlights the utility of a modified free flap approach for anatomically limited palatal fistulas, offering both functional rehabilitation and aesthetic improvement in complex craniofacial conditions.