Skip to main content
Erschienen in: Oral and Maxillofacial Surgery 1/2020

01.03.2020 | Original Article

Tongue flap: a “workhorse flap” in repair of recurrent palatal fistulae

verfasst von: Nimish Gupta, Sujeeth Shetty, Saikrishna Degala

Erschienen in: Oral and Maxillofacial Surgery | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Aim and objective

A prospective study done to evaluate the efficacy of tongue flaps in secondary palatal defects, in terms of functionality, esthetics, and donor site morbidity, and to clarify the technique of elevating and insetting of tongue flap.

Materials and method

Twenty patients having recurrent secondary palatal fistula, post cleft treatment were treated with anteriorly and posteriorly based dorsal tongue flaps. Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and articulation, donor site morbidity, and esthetics.

Results

Twenty patients in age range of 11–24 years, with secondary palatal fistulae, were treated with anteriorly/posteriorly based tongue flap. There were two recurrences as the flap got detached in one patient and necrosis of flap in another. In other patients, healing was uneventful. The flap showed good success rate in terms of uptake and correction of oronasal regurgitation, with imperceptible donor site morbidity. With speech therapy assistance and periodic evaluation by a therapist, significant improvement in speech and articulation was noted over time in all successfully healed patients.

Conclusion

Use of tongue flap for repair of palatal fistulae is a successful technique as it provides appreciable quality and quantity of well-vascularized tissue for fistula closure with negligible functional and esthetic morbidity associated with donor site. As per our study, it is a reliable technique for palatal fistula closure. It even provides good speech improvement over time.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Pigott RW, Rieger FW, Frazer Moodie A (1984) Tongue flap repair of cleft palate fistulae. Br J Plast Surg 37:285–293CrossRef Pigott RW, Rieger FW, Frazer Moodie A (1984) Tongue flap repair of cleft palate fistulae. Br J Plast Surg 37:285–293CrossRef
2.
Zurück zum Zitat Posnick JC, Getz SB (1987) Surgical closure of end stage palatal fistulas using anteriorly- based dorsal tongue flap. J Oral Maxillofac Surg 45:907–912CrossRef Posnick JC, Getz SB (1987) Surgical closure of end stage palatal fistulas using anteriorly- based dorsal tongue flap. J Oral Maxillofac Surg 45:907–912CrossRef
3.
Zurück zum Zitat Ogle OE (2002) The management of oronasal fistulas in the cleft palate patient. Oral Maxillofac Surg Clin N Am 14:553–562CrossRef Ogle OE (2002) The management of oronasal fistulas in the cleft palate patient. Oral Maxillofac Surg Clin N Am 14:553–562CrossRef
4.
Zurück zum Zitat Awang MN (1988) Closure of oroantral fistula. Int J Oral Maxillofac Surg 17:110–115CrossRef Awang MN (1988) Closure of oroantral fistula. Int J Oral Maxillofac Surg 17:110–115CrossRef
5.
Zurück zum Zitat Buchbinder D, St-Hilaire H (2003) Tongue flaps in maxillofacial surgery. Oral Maxillofac Surg Clin N Am 15:475–486CrossRef Buchbinder D, St-Hilaire H (2003) Tongue flaps in maxillofacial surgery. Oral Maxillofac Surg Clin N Am 15:475–486CrossRef
6.
Zurück zum Zitat Steinhauser EW (1982) Experience with dorsal tongue flaps for closure of defects of the hard palate. J Oral Maxillofac Surg 40:787–789CrossRef Steinhauser EW (1982) Experience with dorsal tongue flaps for closure of defects of the hard palate. J Oral Maxillofac Surg 40:787–789CrossRef
7.
Zurück zum Zitat Cadenat H, Combelle R, Fabie M, Lambeaux de langue (1973) Vascularisation, morphologie et utilisation. Ann Chir Plast 18:223–227PubMed Cadenat H, Combelle R, Fabie M, Lambeaux de langue (1973) Vascularisation, morphologie et utilisation. Ann Chir Plast 18:223–227PubMed
8.
Zurück zum Zitat Bracka A (1981) The blood supply of dorsal tongue flap. Br J Plast Surg 34:379–384CrossRef Bracka A (1981) The blood supply of dorsal tongue flap. Br J Plast Surg 34:379–384CrossRef
9.
Zurück zum Zitat Shangkuan H, Xinghai W, Zengxing W et al (1998) Anatomic bases of tongue flaps. Surg Radiol Anat 20:83CrossRef Shangkuan H, Xinghai W, Zengxing W et al (1998) Anatomic bases of tongue flaps. Surg Radiol Anat 20:83CrossRef
10.
Zurück zum Zitat Kinnerbrew MC, Malloy RB (1983) Posteriorly based, lateral lingual flaps for alveolar cleft bone graft coverage. J Oral Maxillofac Surg 41:555–561CrossRef Kinnerbrew MC, Malloy RB (1983) Posteriorly based, lateral lingual flaps for alveolar cleft bone graft coverage. J Oral Maxillofac Surg 41:555–561CrossRef
11.
Zurück zum Zitat Sweeney T, Sell D (2008) Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction. Int J Lang Commun Dis 43(3):265–282CrossRef Sweeney T, Sell D (2008) Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction. Int J Lang Commun Dis 43(3):265–282CrossRef
12.
Zurück zum Zitat Smith TS, Schaberg SJ, Collins JT (1982) Repair of a palatal defect using a dorsal pedicle tongue flap. J Oral Maxillofac Surg 40:670–673CrossRef Smith TS, Schaberg SJ, Collins JT (1982) Repair of a palatal defect using a dorsal pedicle tongue flap. J Oral Maxillofac Surg 40:670–673CrossRef
13.
Zurück zum Zitat Jackson IT, Fasching MC (1990) Secondary deformities of cleft lip, nose and cleft palate. In: JG MC, May JW Jr, Litter JW (eds) Plastic surgery, vol 4. Cleft lip and palate and craniofacial anomalies, chapt 56. Saunders, Philadelphia, p 2771 Jackson IT, Fasching MC (1990) Secondary deformities of cleft lip, nose and cleft palate. In: JG MC, May JW Jr, Litter JW (eds) Plastic surgery, vol 4. Cleft lip and palate and craniofacial anomalies, chapt 56. Saunders, Philadelphia, p 2771
14.
Zurück zum Zitat Lehman JA, Curtin P, Haas DG (1995) Closure of palatal fistulas. Oper Tech Plast Reconstr Surg 2:255–262CrossRef Lehman JA, Curtin P, Haas DG (1995) Closure of palatal fistulas. Oper Tech Plast Reconstr Surg 2:255–262CrossRef
15.
Zurück zum Zitat Tessier P (1976) Anatomical classification of facial, craniofacial and laterofacial clefts. J Maxillofac Surg 4:69CrossRef Tessier P (1976) Anatomical classification of facial, craniofacial and laterofacial clefts. J Maxillofac Surg 4:69CrossRef
16.
Zurück zum Zitat Denny AD, Amm CA (2005) Surgical technique for the correction of postpalatoplasty fistulae of the hard palate. Plast Reconstr Surg 115:383–387CrossRef Denny AD, Amm CA (2005) Surgical technique for the correction of postpalatoplasty fistulae of the hard palate. Plast Reconstr Surg 115:383–387CrossRef
17.
Zurück zum Zitat Abyholm FE, Borchgrevnik HH, Eskeland G (1979) Palatal fistulae following cleft palate surgery. Scand J Plast Reconstr Surg 13:295CrossRef Abyholm FE, Borchgrevnik HH, Eskeland G (1979) Palatal fistulae following cleft palate surgery. Scand J Plast Reconstr Surg 13:295CrossRef
18.
Zurück zum Zitat Schultz RC (1986) Management and timing of cleft palate fistulae repair. Plast Reconstr Surg 78:739CrossRef Schultz RC (1986) Management and timing of cleft palate fistulae repair. Plast Reconstr Surg 78:739CrossRef
19.
Zurück zum Zitat Wilhelmi BJ, Appelt EA, Hill L, Blackwell SJ (2001) Palatal fistulas: rare with the two-flap palatoplasty repair. Plast Reconstr Surg 107:315–318CrossRef Wilhelmi BJ, Appelt EA, Hill L, Blackwell SJ (2001) Palatal fistulas: rare with the two-flap palatoplasty repair. Plast Reconstr Surg 107:315–318CrossRef
20.
Zurück zum Zitat de S. Amaratunga NA (1988) Occurrence of oronasal fistula in operated cleft palate patients. J Oral Maxillofac Surg 46:834–837CrossRef de S. Amaratunga NA (1988) Occurrence of oronasal fistula in operated cleft palate patients. J Oral Maxillofac Surg 46:834–837CrossRef
21.
Zurück zum Zitat Coghlan K, O’Regan B, Carter J (1989) Tongue flap repair of oro-nasal fistulae in cleft palate patients: a review of 20 patients. J Craniomaxillofac Surg 17:255–259CrossRef Coghlan K, O’Regan B, Carter J (1989) Tongue flap repair of oro-nasal fistulae in cleft palate patients: a review of 20 patients. J Craniomaxillofac Surg 17:255–259CrossRef
22.
Zurück zum Zitat Jackson IT (1972) Use of tongue flap to resurface lip defects and close palatal fistula in children. Plast Reconstr Surg 49:537–541CrossRef Jackson IT (1972) Use of tongue flap to resurface lip defects and close palatal fistula in children. Plast Reconstr Surg 49:537–541CrossRef
23.
Zurück zum Zitat Golden GT, Mentzer RM, Fox JW et al (1976) Basket suspension as an adjunct to tongue flap closure of hard palate defects. Cleft Palate J 13:350–353PubMed Golden GT, Mentzer RM, Fox JW et al (1976) Basket suspension as an adjunct to tongue flap closure of hard palate defects. Cleft Palate J 13:350–353PubMed
24.
Zurück zum Zitat Sachs SA, Kay SA, Specter J et al (1979) Treatment of persistent oro-antral fistula with a posteriorly based lateral tongue flap. Int J Oral Maxillofac Surg 8(3):225–228 Sachs SA, Kay SA, Specter J et al (1979) Treatment of persistent oro-antral fistula with a posteriorly based lateral tongue flap. Int J Oral Maxillofac Surg 8(3):225–228
25.
Zurück zum Zitat Abdollahi S, Jabbari Moghaddam Y, Rezan R et al (2008) Results of difficult large palatal fistula repair by tongue flap. Rawal Med J 33:56–58 Abdollahi S, Jabbari Moghaddam Y, Rezan R et al (2008) Results of difficult large palatal fistula repair by tongue flap. Rawal Med J 33:56–58
26.
Zurück zum Zitat Kim M-J, Lee J-H, Choi J-Y, Kang N, Lee J-H, Choi W-J (2001) Two-staged reconstruction of bilateral alveolar cleft using Y-shaped anterior-based tongue flap and ileac bone graft. Cleft Palate Craniofac J 38(5):432–437CrossRef Kim M-J, Lee J-H, Choi J-Y, Kang N, Lee J-H, Choi W-J (2001) Two-staged reconstruction of bilateral alveolar cleft using Y-shaped anterior-based tongue flap and ileac bone graft. Cleft Palate Craniofac J 38(5):432–437CrossRef
27.
Zurück zum Zitat Jackson MS, Jackson IT, Christie FB (1976) Improvement in speech following closure of anterior palatal fistulae with bone graft. Br J Plast Surg 29:295CrossRef Jackson MS, Jackson IT, Christie FB (1976) Improvement in speech following closure of anterior palatal fistulae with bone graft. Br J Plast Surg 29:295CrossRef
28.
Zurück zum Zitat Ceran C, Demirseren ME, Sarici M et al (2013) Tongue flap as a reconstructive option in intraoral defects. J Craniofac Surg 24(3):972–974CrossRef Ceran C, Demirseren ME, Sarici M et al (2013) Tongue flap as a reconstructive option in intraoral defects. J Craniofac Surg 24(3):972–974CrossRef
Metadaten
Titel
Tongue flap: a “workhorse flap” in repair of recurrent palatal fistulae
verfasst von
Nimish Gupta
Sujeeth Shetty
Saikrishna Degala
Publikationsdatum
01.03.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Oral and Maxillofacial Surgery / Ausgabe 1/2020
Print ISSN: 1865-1550
Elektronische ISSN: 1865-1569
DOI
https://doi.org/10.1007/s10006-019-00823-9

Weitere Artikel der Ausgabe 1/2020

Oral and Maxillofacial Surgery 1/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.