Novel technique for the repair of recurrent oronasal fistula using autologous auricular composite graft: Clinical outcomes from a case series.

Background: Oronasal fistulas are common complications of cleft palate surgery. The treatment of recurrent oronasal fistulas is challenging. Several techniques have been reported for the closure of oronasal fistulas. The fistula closure rate varies according to the method used. This study introduces a novel technique using autologous auricular skin-cartilage composite grafts for the treatment of recurrent oronasal fistulas and evaluates the clinical outcomes. Methods: Thirteen patients with recurrent oronasal fistulas who had previously undergone unsuccessful fistula repair were treated using composite grafts harvested from the auricular concha. Surgical outcomes, complications, and donor site morbidity rates were retrospectively reviewed. Results: Complete closure was achieved in nine of the 13 cases (69 %) using a single procedure. Three patients underwent repeat surgery, resulting in closure in two additional cases. The overall fistula closure rate was 85 %. No significant donor-site morbidity or postoperative palatal deformities were observed. Minor residual fistulas in two patients were successfully closed during subsequent alveolar bone grafting. Conclusion: Auricular skin-cartilage composite grafting is a promising option for the management of recurrent oronasal fistulas. This technique provides reliable structural support and mucosal integration with minimal donor site complications. It may be considered as a first-line approach in selected refractory cases, although further studies are needed to confirm its long-term outcomes.