Palatal Flap Delay and Facial Artery Musculomucosal (FAMM) Flap for the Closure of Cocaine Fistula

Objectives: To present a new protocol for closure of cocaine fistulae using a combination of palatal flap delay and facial artery musculomucosal flap demonstrating its reliability for closing these challenging defects and its advantages compared to the other used techniques such as turned over palatal, tongue, temporalis muscle, and radial forearm free flaps. Methods: Eight patients presenting with oronasal communication who admitted sniffing cocaine were treated using palatal flap delay in combination with facial artery musculomucosal flap after quitting cocaine abuse. All cases were followed up for a period of 12-18 months where healing pattern, signs and symptoms of breakdown, recurrence, or residual fistulae in addition to patient satisfaction using a visual analog scale were evaluated. Results: All eight patients showed a very good healing pattern without any signs and symptoms of breakdown, recurrence, or residual fistulae. VAS assessment for patient satisfaction where 10 being the most satisfied showed that four patients reported score 10, three reported score 9, and one reported score 8. Conclusions: The combination of palatal flap delay and FAMM flap is very reliable for cocaine fistulae closure.