Name of the Procedure:

Repair fistula; oronasal Common Names: Oronasal fistula repair, Palatal fistula repair

Summary

Oronasal fistula repair is a surgical procedure to close an abnormal opening (fistula) between the oral cavity (mouth) and the nasal cavity. This opening can cause issues such as feeding difficulties, nasal regurgitation, nasal speech, and recurrent infections.

Purpose

The procedure aims to close the abnormal passage to restore normal function and anatomy. The expected outcome is the elimination of nasal regurgitation, improvement in speech, and reduction in the risk of infections.

Indications

• Persistent nasal regurgitation of fluids and food.
• Chronic nasal and oral infections.
• Speech difficulties, such as hypernasal speech.
• Visible or symptomatic opening between the mouth and nasal cavity.
• Previous surgery (e.g., cleft palate repair) that resulted in a fistula.

Preparation

• Fasting for 6-8 hours before the procedure if general anesthesia will be used.
• Adjustments to current medications as advised by the surgeon or anesthesiologist.
• Preoperative assessments, including blood tests, imaging (e.g., X-rays, CT scans), and a thorough physical examination.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free during the procedure.
2. Incision: An incision is made around the fistula to expose the abnormal opening.
3. Tissue Mobilization: Surrounding tissues are carefully mobilized to ensure they can be used to close the opening without tension.
4. Closure: The fistula is closed using sutures. In some cases, additional grafts or flaps of tissue may be used to ensure a robust repair.
5. Suturing: The incision is closed with sutures that may dissolve over time or require removal during a follow-up visit.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity of the fistula.

Setting

The procedure is performed in a hospital or surgical center equipped with operating facilities.

Personnel

• Surgeon (often a plastic surgeon or an ENT specialist)
• Anesthesiologist
• Surgical nurses
• Support staff

Risks and Complications

• Infection at the surgery site.
• Bleeding during or after surgery.
• Recurrence of the fistula.
• Difficulty with wound healing.
• Adverse reactions to anesthesia.

Benefits

• Reduction or elimination of nasal regurgitation.
• Improved speech quality and clarity.
• Decreased risk of recurrent infections.
• Enhanced quality of life and ability to eat and speak normally.

Recovery

• Post-operative instructions will include pain management, often with prescribed or over-the-counter pain relievers.
• Patients might need to follow a soft or liquid diet initially.
• Avoid inserting objects into the mouth and limit strenuous activities for a few weeks.
• Follow-up appointments will be scheduled to monitor healing and remove any non-dissolvable sutures.
• Recovery typically takes a few weeks, with most patients resuming normal activities in 2 to 4 weeks.

Alternatives

• Non-surgical management, including dental prosthetics or obturators to cover the fistula (less effective long-term).
• Repeat or alternative surgical techniques if the first repair fails.
• Pros: Non-surgical options may offer temporary relief and are less invasive.
• Cons: They generally do not provide a permanent solution and require ongoing maintenance.

Patient Experience

• During the procedure: Patients will be under general anesthesia and will not experience any pain or discomfort during the surgery.
• After the procedure: Some post-operative pain and swelling is normal, managed by prescribed medications. Patients may experience some discomfort while eating or speaking initially but this improves as healing progresses.
• Pain Management: Pain is usually managed with prescribed analgesics. Cold packs and rest can also help alleviate discomfort.

Pain management, proper rest, and adherence to post-operative care instructions are paramount for a smooth recovery.