Illustration of successful cleft palate fistula repair with FAMM flap.

Cleft Palate Fistulas: Understanding Repair Options and the FAMM Flap

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"Explore the effectiveness of the Facial Artery Musculo-Mucosal (FAMM) flap in repairing palatal fistulas, offering hope and improved outcomes for patients with congenital cleft palates."

Cleft palate fistulas, abnormal openings between the oral and nasal cavities, are a common complication following cleft palate repair. These fistulas can lead to a range of challenges, impacting speech, feeding, and overall quality of life. While various reconstructive options exist, finding a reliable method for moderate to large fistulas remains a significant pursuit in the field of reconstructive surgery.

Traditional approaches often face limitations due to the scarcity of local tissue and the presence of scar tissue from previous surgeries. This is where the Facial Artery Musculo-Mucosal (FAMM) flap has emerged as a promising solution. The FAMM flap utilizes tissue from the cheek, supplied by the facial artery, to provide a well-vascularized graft for fistula closure.

This article explores the use of the FAMM flap in palatal fistula repair, drawing upon a study published in the Cirugía Plástica Ibero-Latinoamericana. We will delve into the procedure itself, patient outcomes, and the advantages of this technique in addressing the challenges posed by cleft palate fistulas.

What is the FAMM Flap and How Does It Work?

Illustration of successful cleft palate fistula repair with FAMM flap.

The FAMM flap is a versatile reconstructive technique that utilizes a flap of tissue from the inner cheek, including the muscle and mucous membrane. What sets it apart is its reliance on the facial artery for a consistent and robust blood supply. This reliable vascularization is crucial for the survival and integration of the graft in the recipient site.

Here's a breakdown of the key elements:

Facial Artery: The primary blood supply for the flap, ensuring its viability.
Musculo-Mucosal Tissue: The tissue harvested from the inner cheek, providing a suitable graft for fistula closure.
Flap Design: The flap can be designed in various ways (e.g., superiorly or inferiorly based) to accommodate the specific location and size of the fistula.

The surgeon carefully dissects the flap, preserving the facial artery and vein. The flap is then rotated and positioned to cover the palatal fistula, with meticulous suturing to ensure a secure and watertight closure. In cases where the flap crosses the alveolar ridge, a temporary dental modification or a second procedure may be necessary to prevent pressure on the pedicle as teeth erupt.

Is the FAMM Flap the Right Choice for You?

The FAMM flap has emerged as a valuable tool in the reconstruction of palatal fistulas, particularly those of moderate to large size. Its reliable blood supply, versatility in design, and relatively low complication rate make it an attractive option for surgeons experienced in this technique. If you or a loved one is considering options for palatal fistula repair, discuss the FAMM flap with a qualified surgeon to determine if it is the most appropriate approach for your specific needs.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4321/s0376-78922014000300004, Alternate LINK

Title: Colgajo Famm Para Reconstrucción De Fístulas De Paladar En Pacientes Con Fisura Palatina Congénita: Experiencia Y Resultados

Subject: Surgery

Journal: Cirugía Plástica Ibero-Latinoamericana

Publisher: SciELO Espana/Repisalud

Authors: R. López-Sánchez, B. Berenguer-Fröhner, B. González-Meli, P. Rodríguez-Urcelay, C. Marín-Molina, E. De Tomás-Palacios, T. Núñez-Villaveirán

Published: 2014-09-01

Everything You Need To Know

What is a cleft palate fistula, and why is repairing it important?

A cleft palate fistula is an abnormal opening between the oral and nasal cavities, often occurring after cleft palate repair. These fistulas can cause problems with speech, feeding, and overall quality of life. Repairing the fistula is crucial to restore normal function and improve the patient's well-being. Without repair, individuals may experience nasal regurgitation of food and liquids, speech difficulties characterized by nasal air emission, and potential social challenges due to these functional impairments.

What is the FAMM flap, and how does it work in repairing palatal fistulas?

The Facial Artery Musculo-Mucosal (FAMM) flap is a surgical technique used to repair palatal fistulas. It involves taking a flap of tissue from the inner cheek, including the muscle and mucous membrane, and utilizing the facial artery for its blood supply. The surgeon carefully dissects this flap and rotates it to cover the palatal fistula, providing a well-vascularized graft that promotes healing and closure of the opening. The flap's design can be adjusted based on the fistula's location and size.

What are the advantages of using the FAMM flap over traditional methods for palatal fistula repair?

The FAMM flap offers several advantages over traditional approaches. It addresses limitations related to the scarcity of local tissue and the presence of scar tissue often found in previous surgical sites. The flap's robust blood supply, provided by the facial artery, ensures the graft's viability and successful integration. Its versatility in design allows surgeons to tailor the repair to the specific fistula, making it a reliable solution for moderate to large fistulas. Furthermore, the relatively low complication rate makes it a promising option for improved patient outcomes.

Who is a good candidate for the FAMM flap procedure?

The FAMM flap is particularly well-suited for patients with moderate to large palatal fistulas. The decision to proceed with the FAMM flap is best made in consultation with a qualified surgeon experienced in this technique. The patient's overall health, the specific characteristics of the fistula (size, location), and any prior surgical history are considered to determine if the FAMM flap is the most appropriate approach. It's important to discuss all available options and the potential benefits and risks with the surgical team.

What can I expect during the recovery period after a FAMM flap procedure?

Recovery after the FAMM flap procedure involves careful management. Patients can anticipate some swelling and discomfort at the surgical site. Dietary modifications, such as a soft or liquid diet, are often necessary to protect the repair and promote healing. Oral hygiene is crucial, and the surgeon will provide specific instructions on how to care for the surgical area. Depending on the flap's positioning, temporary dental modifications or a second procedure might be required to prevent pressure on the flap's blood supply. Regular follow-up appointments will be scheduled to monitor healing and address any complications.