This is a 5-year-old female patient referred to our department with a diagnosis of oronasal fistula. Her history included bilateral cheiloplasty and palatoplasty of the soft palate at the age of 6 months and palatoplasty of the hard palate at the age of 4 years, with the latter procedure presenting a dehiscence (oronasal fistula) that caused rhinophonia and nasal reflux of food. On intraoral examination we observed an oronasal fistula at the junction of the primary and secondary palate on the left side measuring approximately 12mm x 25mm.

It was planned to close the fistula with an anteriorly based lingual flap due to the size of the defect.
Technique
Under general anaesthesia with nasotracheal intubation the palatal defect is contoured by taking a tissue margin of approximately 8mm. The mucosa overlying and surrounding the fistula is unfolded and its edges are faced to create a nasal floor.
An aluminium template is made with the dimensions of the fistula, from which a slightly larger flap is designed. The lateral edges of the tongue are sutured to a horseshoe-shaped acrylic plate, which is intended to stabilise and support the tongue to facilitate taking the flap.

Once the tongue flap has been obtained, the primary closure of the lingual cruciate area is performed. The flap is then positioned over the oronasal fistula and suturing is started from back to front.

Twenty-one days after surgery a perfusion test was performed, no evidence of ischaemia was observed and the pedicle was removed under local anaesthesia.
Satisfactory closure of the fistula was achieved, a small dehiscence occurred in the immediate postoperative period, which closed spontaneously after three months.