Inclusion Criteria:  Patients with recurrent small and medium sized oronasal fistula failed after several attempts closure, up to 10 mm regardless of number of recurrence and position of the fistula. Age group : from 18 to 60 years old. No sex predilection. Patients with no contraindications to surgical intervention. Patients accepting consent for extracting one teeth in the surgical field if needed. Patients proved with Doppler study with a patent facial artery course.  Exclusion Criteria:  Patients with systemic condition counteracting with the surgical procedure. Patients who underwent a previously ipsilateral cheek flap except for midline fistulae.