Tongue flap as salvage procedure for recurrent and large palatal fistula after cleft palate repair

Abstract

Background: Recurrent palatal fistula is a common complication of cleft palate repair. The main causes are poor surgical technique or vascular accidents and infection. Local flaps are not adequate for larger and recurrent fistula. The aim of this study is to analyze the utility of tongue flap in recurrent and large palatal fistula repair. Materials and Methods: From January 2008 to July 2016, 18 patients with recurrent palatal fistula were included in the study. All the patients had undergone repair of cleft palate and fistula previously. Tongue flap repair of the recurrent palatal fistula was performed in all 18 patients. The flaps were divided after 3 weeks and final inset was done. Flap viability, fistula closure, residual tongue function, esthetics, and speech impediment were assessed. Results: In all the patients, fistula could be closed primarily by tongue flap. None of the patients developed flap necrosis while flap dehiscence and bleeding were observed in one patient each. No functional deformity of the tongue and donor-site morbidity was seen. Speech was improved in 80% cases. Conclusion: The central position, mobility, excellent vascularity, and versatility of tongue flap make particularly suitable choice for the repair of large fistula in palates scarred by previous surgery. It is very well tolerated by children. We, therefore, recommend tongue flap for large and recurrent palatal fistula in children.

Reconstruction of persistent oronasal communication using an anteriorly based tongue flap following failed cleft palate repair—Report of two cases

“…This hypothesis is supported by the fact that the flap is associated with a relative lack of complications and has shown high success rates among our cases as well as those reported by others hence preserving the limited resources of these patients. Success rates varying from 85% to 95.5% have been reported provided that the case selection is genuine 2,15,16 . As the flap is interpolated and must be maintained this way for 2–3 weeks, it may not be ideal in young children or among children with special needs as there may be uncontrolled tension on the flap which may lead to detachment from the palate 17 …”

“…Success rates varying from 85% to 95.5% have been reported provided that the case selection is genuine. 2,15,16 As the flap is interpolated and must be maintained this way for 2-3 weeks, it may not be ideal in young children or among children with special needs as there may be uncontrolled tension on the flap which may lead to detachment from the palate. 17 Some of the drawbacks of the tongue flap are the difficulties in intubation and extubation intraoperatively, limited intraoral function, and risk of detachment.…”

Tongue Flap for Management of Large Palatal Fistulas

“…[11][12][13][14][15][16][17][18][19] We consider in terms of a secure grip, 21 days to be sufficient time to pass before the second surgery where a section of the flap is made, just as published by Sodhi and Prakash. 17,20 Study limitations: being a retrospective investigation and lack of available data about primary palatoplasty before referral to our center.…”

“…We consider in terms of a secure grip, 21 days to be sufficient time to pass before the second surgery where a section of the flap is made, just as published by Sodhi and Prakash. 17,20…”

Usage of platelet-rich fibrin (PRF) membranes for closure of soft palate recurrent fistula

“…Treatment o of palatal fistulas is technically challenging, and different techniques are described in the literature, including local and regional flaps, tissue grafts, pedicle flaps, and obturator prosthesis [3,5]. The choice of a specific technique depends on factors such as location, size of the fistula, and patient age [2].…”