A new combined flap for closure of a large alveolar fistula in a critical patient: A case report

Alveolar fistulas are frequent complications in patients with cleft lip and palate, often associated with failed surgeries and disrupted maxillary continuity. Their management remains challenging, particularly in recurrent cases with extensive scarring. We describe a novel combined flap technique for the closure of a large recurrent alveolar fistula in a complex patient. A 30-year-old edentulous female, active smoker and former drug addict, presented with a 1.5 cm multi-operated alveolar fistula and an untreated alveolar bone cleft. Previous attempts at closure with bone grafts and mucoperiosteal flaps had failed. We designed an upper lip mucosal flap for oral closure, combined with a nasoseptal mucosal flap to reconstruct the nasal lining. The combined flap achieved complete closure of the fistula without compromising lip mobility, oral function, or vestibular depth. The patient reported resolution of nasal regurgitation and hypernasal speech, with no donor-site morbidity and satisfactory healing. This combined upper lip mucosal and nasoseptal flap provided well-vascularized, robust tissue for closure of a large recurrent alveolar fistula, while preserving function and patient comfort. It represents a valuable alternative for complex cases where conventional techniques are unsuitable or have failed. • Recurrent alveolar fistulas are challenging due to scarring and poor vascularization. • Conventional flaps frequently fail in multi-operated fistula. • A novel upper lip–nasoseptal flap closed the defect with well-vascularized, healthy tissue. • The method preserved lip function and ensured patient comfort. • Provides a valuable alternative when conventional techniques fail.