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CASE REPORT Table of Contents   
Year : 2014  |  Volume : 11  |  Issue : 1  |  Page : 82-83
Repair of large palatal fistula using tongue flap


Pediatric Plastic Surgery Department, Child Hospital, CHU IBN SINA, Rabat, Morocco

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Date of Web Publication20-Mar-2014
 

   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.

Keywords: Cleft surgery, fistula, palate, tongue flap

How to cite this article:
Nawfal F, Hicham B, Achraf B, Rachid B. Repair of large palatal fistula using tongue flap. Afr J Paediatr Surg 2014;11:82-3

How to cite this URL:
Nawfal F, Hicham B, Achraf B, Rachid B. Repair of large palatal fistula using tongue flap. Afr J Paediatr Surg [serial online] 2014 [cited 2019 Aug 19];11:82-3. Available from: http://www.afrjpaedsurg.org/text.asp?2014/11/1/82/129247

   Introduction Top


Large fistulas of the hard palate are not uncommon and represent a big challenge for cleft surgeons. Multiple failures at cleft palate repair leave behind a scarred palate, with bad quality tissue available for closure. In these cases, a tongue flap is a good alternative. The authors report a case of a large palatal fistula closure with anteriorly based tongue flap.


   Case Report Top


A 2-year-old boy presented with a large palatal fistula measuring 4, 5 cm × 2 cm 1 year after repair of bilateral cleft lip and palate [Figure 1]a. His fistula was secondary to a hard palate necrosis after primary closure procedure. Because the local tissue was inadequate for fistula closure, a tongue flap was indicated.
Figure 1: Large hard palate fistula after bilateral cleft palate repair. (b) Nasal layer repaired by mobilisation of marginal flaps from the hard palate and vomer flaps. Design of an anterior based tongue flap. (c) Dissection of the flap.(d) Aspect at 3 weeks after the procedure. (e) Depedicling of the flap. We can see flap congestion. (f) The palate 3 weeks after depedicling the tongue flap

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The fistula was closed under general anaesthesia with nasotracheal intubation. An incision was made around the margins of the fistula and in the vomer. The mucosa of palatal margins and vomer flaps were then mobilised, following which the nasal lining was reconstructed by approximating the marginal flaps and vomer flaps using 5-0 vicryl sutures. An anteriorly based flap was designed in the tongue [Figure 1]b.

The thickness of the flap was 3 mm and deeper at its base to ensure a good blood supply [Figure 1]c. After checking the viability of flap, the donor site was then closed directly and the flap was fixed to the palate using 4-0 vicryl. A naso gastric tube was put to unsure feeding. After 3 weeks, the pedicle was divided and the pedicle remnant was returned to the tongue [Figure 1]d and e. The complete healing was obtained after 2 weeks and the patient does not have any residual fistula [Figure 1]f.


   Discussion Top


Management of large palate fistula remains a serious problem especially after many attempts at closure. Many procedures are possible to restore this defect: Obturators which are not well tolerated in the long run and autologue flaps. [1],[2]

The tongue is one of the most donor sites for flap oral cavity reconstruction.

Guerrero-Santos and Altamirano, were the first to report on the use of tongue flaps for palatal defect closure. [3]

Its good vascularisation from the lingual artery and its branches [1] permits different flap designs: Anterior based flap, posterior based flap, lateral flap, median flap and central island flap.

The tongue flap is easy and reproducible with excellent esthetical and functional results. The advantages are the use of adjacent tissue, the excellent blood supply and the low morbidity in donor site.

However, some disadvantages can be noted: Use of naso gastric tube for alimentation, inability in swallowing and speech until depedicling of the flap and in some cases the attachment of the flap can be lost due to traction. Guerrero-Santos and Altamirano suggested fixing the tip of the tongue to the upper lip to reduce the mobility of the tongue. [3],[4]

 
   References Top

1.Elyassi AR, Helling ER, Closmann JJ. Closure of difficult palatal fistulas using a "parachuting and anchoring" technique with the tongue flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:711-4.  Back to cited text no. 1
    
2.Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: A review of the literature. J Oral Maxillofac Surg 2010;68:1384-91.  Back to cited text no. 2
    
3.Guerrero-Santos J, Altamirano JT. The use of lingual flaps in repair of fistulas of the hard palate. Plast Reconstr Surg 1966;38:123-8.  Back to cited text no. 3
[PUBMED]    
4.Agrawal K, Panda KN. Management of a detached tongue flap. Plast Reconstr Surg 2007;120:151-6.  Back to cited text no. 4
    

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Correspondence Address:
Fejjal Nawfal
Secteur 23, Résidence Nakhil Riad, Imm 14, Apt 4, Hay Riad, Rabat
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.129247

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