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Ann Maxillofac Surg. 2015 Jul-Dec;5(2):174-8. doi: 10.4103/2231-0746.175767.

Posteriorly based lateral tongue flap for reconstruction of large palatal-alveolar fistulas in cleft patients.

Author information

1
Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
2
Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

BACKGROUND:

Large palatal fistula in cleft patients is a difficult situation, especially with previous multiple surgeries, which have led to severe scars in the palatal mucosa. Tongue flaps are useful aids in such situations.

MATERIALS AND METHODS:

Seven cleft patients who were reconstructed by posteriorly based lateral tongue flap between 2005 and 2012 were studied. Variables such as flap-ability to close the fistula, remaining tongue shape at least 1 year after operation, and speech improvement (patients' self-assessment) were evaluated.

RESULTS:

Age range of the patients was 14‒45 years. The male-to-female ratio was 2/7. Posteriorly based lateral tongue flap effectively closed the large fistula in 6/7 of patients. The largest dimensions of fistula closed by this flap was 5 cm × 1.5 cm. Follow-up of 2‒7 years showed that the tongue never returned to the original size and remained asymmetrical. In addition, the nasal speech did not improve dramatically after the closure of large palatal/alveolar fistulas in this age group.

CONCLUSION:

Posteriorly based lateral tongue flap is an effective method to solve the problem of large palatal fistulas in adult cleft patients. The most useful indication for this flap is a large longitudinal palatal fistula, extending to the alveolar process. Asymmetrical tongue shape after surgery is the rule and speech improvement depends on patient's age and location of fistula.

KEYWORDS:

Palatal fistula; reconstruction; tongue flap

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