Use of tongue flap as alternative for the closure of Palatinal fistulas in patients with sequela of palatoplasty.

Abstract

Venezuela, which describes the procedure and protocol of the postoperative period of patients operated on multiple occasions for the closure of palatal fistulas. Material and methods: A total of 20 patients treated for palatal fistulas were included in this study, in the period between 2014-2018. Patients with presence of sequelae of palatal fistulas, large fistulas with inadequate local scars, presence of oronasal communication and hypernasal resonance were considered. Patients were evaluated during the first 24 hours, 21 days and 6 months. Results: A total of 20 patients (12 men and 8 women) with palatal fistulas were treated with tongue flap, aged between 25 and 40 years. In the postoperative period, patients reported 58 % of cases, mild pain. The most frequent clinical signs during the postoperative period were presented in 60 % of the patients, showing headache, passive bleeding, severe pain. No significant changes in lingual motility. Acoustic analysis of the 6-month late postoperative control voice, presented favorable changes in the intonation line, showing its continuity. All remaining cases showed satisfactory cure, and donor site morbidity was minimal. Conclusions: The tongue flaps are an excellent alternative for closing large or recurrent palatal fistulas, due to their versatility and excellent vascularity of the area. However, the design and the delicate manipulation of the flap are also decisive.

Tongue Flap for Management of Large Palatal Fistulas

“…Nevertheless, 1 has to remember that an important limiting condition is the age of the patient, not being able to present this technique in preadolescents or with behavioral problems because of the obvious effect in the psychological state and the necessary cooperation. Zhou 22 published a case report of a double tongue flap in a patient of only 10 years old, and Vasistha 13 had patients from 4 years of age, not specifying psychological aspects or sociocultural ones in their publications, just as in many of the reports of cases and series.…”

“…Until now, there are no published series about outpatient management of tongue flap in patients with palatine fistulas; nevertheless, Barazarte 22 has a similar management but with 24 hours inpatient surgery, with a low rate of complications. There were 2 types of complications in our series: 2 cases of partial dehiscence of tongue flap in the area of the fistula and 1 residual fistula (8,3%), which were posteriorly repaired without recurrency.…”

“…Until now, there are no published series about outpatient management of tongue flap in patients with palatine fistulas; nevertheless, Barazarte 22 has a similar management but with 24 hours inpatient surgery, with a low rate of complications.…”