Reconstruction of Fistulas Following Cleft Palate Repair.

Fistulas are the most consequential complication of cleft palate repair and have compounding effects on multiple functional domains. Successful reconstruction is critical to resuming the normal pathway of care. The nature of a fistula can be understood considering the multiple axes that define its presentation. Closure involves addressing nasal lining, oral lining, and velar muscle function and options can be organized according to a "reconstructive stepladder". Ultimately, the selection of a strategy considers the fistula, patient, and surgeon/resources; with the goal of robust closure that optimizes speech, growth, dental health, and treatment burden.