Fistula behind premaxilla in cleft patients is the second most common in frequency and the most difficult location for closure. High risk of failure is reported after corrective surgeries in this region. Two layer closures are important in this topic. Reflection of palatal premaxillary mucosa provides a new source for nasal lining that is introduced in this article as a technical note and is explained with four cases. While the premaxillary palatal flap is a promising alternative for closure of these types of clefts, more studies are necessary before it can be universally recommended.
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