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Oral antral fistulas that have been already subjected to previous attempts at closure have been difficult to treat. Gold foil, bony plugs, and other materials have been used for many years to close these fistulas. Because of all of the various techniques and materials used in this procedure, it has been vexing to evaluate their efficacy. Although the persistent fistula is a rare entity, the surgeons faced with treating this condition must understand the principles of flap closure. In six cases in which multiple attempts at oral antral fistula closure had failed, we used either bilateral or unilateral palatal flaps based on the posterior palatine artery. The patients have been followed up for ten years after surgery and can wear dentures if indicated. There has not been any recurrent fistulization in any of these cases.

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A full-thickness graft of hard palate mucosa was used as the lining tissue for eyelid reconstruction in 11 patients over a 7-year period. An orbicularis musculocutaneous flap supplied cover and support. In all cases the mucosal graft was easily removed, convenient to handle, and took completely. The palate donor site reepithelialized by about 3 weeks postoperative and has remained healed and asymptomatic in all cases. In follow-up averaging 3 years, all the reconstructed lids have retained a stable and comfortable lid margin, with no instance of entropion or irritation. The outstanding virtue of palate mucosa for eyelid reconstruction is that it appears to retain most of its original size and stiffness over the long term and thus in a single layer can serve to replace both tarsus and conjunctiva.

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Palatal mucosal grafts are used to provide bulk and improve the contour of lip defects. Since the palatal grafts are markedly different in color, they must be placed behind the wet-dry mucosal line so that they cannot be easily seen at conversational distances. The contrast with the red vermilion is too great for this graft to be used as a cosmetic lip substitute, but when the graft is used as a living tissue expander in the posterior position, it improves subtle lip contours.

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An experimental model was designed to test the hypothesis that the periosteum of the nasal cavity may have an inherent tendency for bone resorption whereas oro-palatal periosteum may have an inherent osteogenic character. This hypothesis was found to be valid and could have important surgical implications in man.

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This study was undertaken in order to evaluate and compare the effectiveness and fate of the nonautogenous scleral graft in relation to similar grafts of bone marrow and epithelium-free connective tissue grafts from the palate. One hundred round osseous defects 2 mm in diameter, were surgically created in the calveria of 25 rats. Three defects in each animal were filled with the various graft materials obtained from isogenic rats sacrificed at the time of preparation of the bony defects. The fourth defect was left empty as a control. The animals were sacrificed at varying periods of time up to 150 days. Histomorphologic evaluation of the graft sites demonstrated the following: (a) Scleral grafts had effected a functionally adequate repair, without apparent histopathologic changes. (b) Fresh bone marrow provided the greatest osteogenic activity when used as a graft implant. The sclera had an insignificant osteogenic activity when used as a graft implant. The sclera had an insignificant osteogenic potential. (c) Epithelium-free connective tissue was the least effective, both as an osteogenic or functionally adequate graft.

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The importance of an adequate amount of keratinized and attached gingiva to maintain gingival health has been stressed by several authors (Friedman & Levine 1964, Lang & Löe 1972, Bernimoulin & Mühlemann 1973) and though the rationale for increasing the width of the gingiva applies equally well to both the lingual and the vestibular surfaces, only one report of a graft on the lingual aspect of the mandible in dentate patients has been found in the literature (Goldman & Cohen 1973). The object of this report is to describe the indications, the surgical procedure devised and the results obtained in two patients.

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We have used a modification of a mucoperiosteal flap described by Lane for cleft palates in 3 patients with oral cavity defects from tumor ablations. The flap provides excellent lining for repairs when alternative flaps are unavailable. The vascularity of the flap and its texture allow a watertight closure which does not hinder the patient's ability to talk or eat.

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After increasing the width of the attached gingiva by free palatal mucosa transplants, 20 procedures with coronal flap repositioning were performed on 41 teeth with gingival recessions in 13 young adults. The amount of gingival recession and the clinical gingival sulcus depth were measured pre-operatively and 1, 6 and 12 months after surgery; the amount of osseous dehiscence was measured during surgery. No significant differences were found among reduction values of gingival recession by reattachment 1, 6 and 12 months post-operatively. Although a significant correlation was found between the degree of gingival recession preoperatively and 1 month post-operatively, non was found between the amount of alveolar bone dehiscence and gingival recession 1 month post-operatively.

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