Repair of large palatal fistula using tongue flap

Abstract

Large palatal fistulas are a challenging problem in cleft surgery. Many techniques are used to close the defect. The tongue flap is an easy and reproductible procedure for managing this complication. The authors report a case of a large palatal fistula closure with anteriorly based tongue flap.

Rotación de colgajo lingual para cierre de fístula palatina en pacientes con labio y paladar fisurados realizado en el Hospital Municipal de la Mujer y el Niño, Cuenca, Ecuador

“…3,4 Para realizar el cierre de los defectos intraorales están indicados tratamientos conservadores como el uso de colgajos vestibulares, palatinos, combinados e incluso injertos óseos. El colgajo lingual está indicado en casos de fístulas recurrentes, paladares con exceso de cicatrices, paladares que poseen poca calidad y cantidad de tejido palatino residual que no permiten un adecuado cierre y en defectos mayores a 1 cm de diá- www.medigraphic.org.mx metro, 1,6,7 Sin embargo, se pueden presentar algunos inconvenientes transoperatorios y postoperatorios, pudiendo ser inmediatos: sangrado, hematoma, epistaxis, pérdida temporal de la sensibilidad y el gusto; y mediatas: infección, dehiscencia, necrosis, no se han reportado alteraciones en la movilidad de la lengua, en la dicción y articulación de palabras, la única secuela reportada es un adelgazamiento de la lengua. 7 Una consideración importante para los pacientes sometidos a colgajos pediculados de dorso de lengua es mantener una alimentación a base de líquidos mínimo 14 días hasta la separación del pedículo.…”

Protocol and Evaluation of 3D-Planned Microsurgical and Dental Implant Reconstruction of Maxillary Cleft Critical Size Defects in Adolescents and Young Adults

“…Local flap reconstruction by means of buccal, tongue, temporal nasolabial, or temporal flaps is insufficient, as each is limited only to soft tissue reconstruction. It may be beneficial in the closure of wide naso-oral fistulas, but it does not resolve the problem of a hard tissue deficiency [ 8 , 9 , 10 ]. Severe deformations are usually regarded as critical, and hence require more complex reconstruction of both the hard and soft tissues in order to provide sufficient and functional reconstruction of the cleft maxilla [ 6 , 11 ].…”

Techniques to Improve Reliability and Predictability of the Dorsal Pedicled Tongue Flap in Closure of Palatal Defects and Oronasal Fistulae

“…Dehiscence of a tongue flap after a traditional procedure is often the result of such activity by the unbridled tongue or from the unrestrained opening of the mouth during yawning or involuntary gagging, which may tug on the pedicle and pull the flap from its attachment. For this reason, some fixation schemes have been previously proposed such as a wire sutured to the tongue tip, passed through and tied to the upper lip [13]; a Kirschner wire (K-wire) placed through the angles of the mandible, transfixing the lingual base and body of the tongue in between [14]; or intermaxillary fixation [15]. A ''parachuting and anchoring'' technique has also been advocated [12,16], in which the tongue flap is parachuted upwards using a catheter drawn into the nose, and is then secured to the nasal septum, thus anchoring it for extra stability.…”