Buccal Sulcus Myomucosal Flap—an Approach for the Closure of Anterior Palatal Fistulae

Anterior palatal fistulae (APFs) present a considerable challenge following cleft palate repair, particularly when involving the alveolus and the anterior half of the hard palate. These defects are notoriously difficult to close due to limited local tissue availability, scarring, restricted flap mobility, and altered vascularity, all contributing to high recurrence rates. This study evaluates the effectiveness of the buccal sulcus myomucosal flap (BSMF) as a practical and reliable option for APF closure. A retrospective review of 132 patients treated between January 2021 and December 2023 was conducted. All patients underwent nasal layer closure with turn-in flaps, followed by measurement of the residual defect and harvest of a BSMF of appropriate size. Of the cohort, 59 patients (44.7%) presented with primary fistulae while 73 (55.3%) had recurrent defects. The overall recurrence rate following repair was 10.4%, with similar rates observed in primary and recurrent cases. The technique consistently achieved tension-free closure even in large anterior defects extending into the alveolus, with minimal donor site morbidity. Its technical simplicity and cost-effectiveness further enhance its applicability, particularly in resource-constrained and high-volume settings. The BSMF offers a reproducible, effective solution for managing anterior palatal fistulae and warrants broader consideration in cleft care algorithms.