Elimination of palatal fistula after the maxillary swing procedure

BACKGROUND: The maxillary swing procedure has been used as an anterolateral approach to expose the nasopharynx, the central skull base, and its vicinity. The reported incidence of postoperative palatal fistula has ranged from 20% to 25%. The oronasal incompetence especially associated with a large fistula has adversely affected normal speech, eating, and swallowing functions. We describe a modified palatal incision to reduce the incidence of palatal fistula associated with the maxillary swing procedure. METHODS: Fifteen consecutive patients who underwent maxillary swing procedures for salvage resection of recurrent nasopharyngeal carcinoma after radiotherapy had the modified palatal incision. The flap was raised as described, and the outcome was analyzed. RESULTS: Fourteen patients' palatal wound healed uneventfully. One patient experienced partial flap necrosis, which healed with conservative treatment. All 15 patients tolerated oral feeding 1 week after the surgery. No palatal fistulas occurred. CONCLUSION: The modified palatal incision as described has effectively prevented palatal fistula formation after the maxillary swing procedure.