Using Reverse Flow Based Flap VS Palatal Pedicled Flap for Closure of Recurrent Small & Medium Sized Oronasal Fistula.

"* Flap will be marked medial to the duct, which limits posterior extent of flap. Anterior flap marking starts 1cm posterior to oral commissure.~* Width of flap was kept to about 2-2.5cm.~* An initial incision will be made 1cm posterior to oral commissure.~* Incision will be deepened through buccal mucosa, submucosa, \& underlying muscles into layer of buccal fat.~* Flap will be dissected in a retrograde or antegrade manner depending on fistula site, maintaining vessels in a central position in the flap.~* Once completely raised, flap inserted \& sutured in place while donor site be closed primarily with 4-0 polyglactin (Vicryl) interrupted sutures.~* Patient's comparator group will be treated by raising a palatal pedicled flap.~* Flap will be outlined extending from palatal mucosa against permanent 2nd molar till permanent canine anteriorly.~* It is rotated towards oronasal fistula \& secured in place using 4 -0 Vicryl interrupted sutures."