Palatal and Oronasal Defects

Risk Factors for Failure of Hard Palate Mucoperiosteal Flap Repair of Acquired Oronasal Communication in Dogs: A Pilot Study

“…Defects in the maxillary, incisive, and palatine bones that result in oronasal communication can develop from numerous conditions and are characterized as congenital or acquired in origin (1)(2)(3)(4)(5)(6)(7). Acquired defects may result from treatment of neoplasia, periodontal disease, erosive disorders of the oral cavity, previous surgery or radiation therapy, or traumatic injuries (1)(2)(3)(4)(5)(6)(7). Malocclusion, especially where the mandibular canine teeth chronically contact the hard palate can also result in oronasal communication (4).…”

“…Surgical repair of oronasal communication is generally indicated to allow for normal function and improved quality of life. Without repair patients may experience chronic upper respiratory infections, sinusitis, food impaction, failure to thrive, and aspiration pneumonia (1)(2)(3)(4)(5)(6)(7). Primary surgical repair of oral cavity defects presents challenges due to the paucity of redundant tissue.…”

“…The anatomical nature of the region limits the ability of primary closure from immediately adjacent tissues surrounding the defect. Hard palate mucoperiosteal flaps (HPF) can provide robust tissue for primary surgical repair of acquired oronasal communication (1)(2)(3)(4)(5)(6)(7).…”

“…The HPF blood supply comes directly from the major palatine artery and smaller random vessels (1)(2)(3)(4)(5)(6)(7)(8). Basic surgical principles including knowledge of anatomy, tension-free closure, preserving adequate blood supply, and delicate tissue handling are essential for successful healing (1)(2)(3)(4)(5)(6)(7). An HPF can be carefully developed as an island for greater mobility and rotated up to 180 • without compromising blood supply (9)(10)(11).…”

“…An HPF can be carefully developed as an island for greater mobility and rotated up to 180° without compromising blood supply ( 9 – 11 ). Dehiscence is the most common complication of oronasal fistula repair ( 4 , 6 , 7 ). Previous studies have listed various reasons for mucosal flap dehiscence such as excessive tension, insufficient bony support underlying the suture line, infection, compromised blood supply, inadequate tissue reservoir for flap development, poor flap design, and poor surgical execution ( 3 , 4 , 6 , 7 ).…”