Surgical Management of Suction 
Cup-induced Palatal Perforation: 
A Case Report

Objective To report a case of a palatal fistula caused by trauma from a removable maxillary denture with a suction cup, and to evaluate the effectiveness of Bardach’s two-layer palatal flap technique for its surgical repair. Methods Palatal fistulas are pathological communications between the oral and nasal cavities, often leading to nasal regurgitation, hypernasal speech, and psychological discomfort. They may result from congenital anomalies like cleft palate, infections such as osteomyelitis, or mechanical trauma, including long-term use of maxillary dentures with suction cups. Surgical repair is often challenging due to limited tissue availability and scar tissue from previous procedures, contributing to a recurrence rate of up to 25%. A case of a patient with a suction cup-induced palatal perforation was managed using Bardach’s two-layer palatal flap technique. This method involves creating bilateral mucoperiosteal flaps from the hard palate and repositioning them to achieve a tension-free, two-layer closure. Results The surgical repair using Bardach’s technique was successful, with the patient experiencing no major postoperative complications. The flap provided adequate coverage with good vascularity and healing, and no recurrence of the fistula was observed during follow-up. Conclusion Bardach’s two-layer palatal flap is a reliable and straightforward surgical approach for repairing small palatal fistulas, especially those caused by trauma. Its advantages include simplicity, a robust blood supply, and minimal donor site morbidity. This case supports the technique’s continued use in similar clinical scenarios to achieve effective and lasting closure of palatal defects.