Double Tongue Flaps for Anterior Huge Palatal Fistula Closure

Abstract

Summary: Even though it is widely accepted that the tongue flap is effective and feasible for repair of huge palatal fistula, there still exist a few failed cases due to the severity or complicated situation. The aim of this paper is to report the validity and feasibility of using double tongue dorsal flaps to repair a huge anterior fistula. A 10-year-old boy diagnosed with Van de Woude syndrome with repaired bilateral cleft lip and palate presented with a huge anterior fistula divided by septum. A double tongue dorsal flap was designed to cover the fistula. The huge unusual anterior palatal fistula was repaired successfully by usage of double pedicle tongue flaps with a follow-up period of 1 month. The double tongue flap is an alternative choice to handle a large residual fistula in anterior part of palate which was divided into 2 fistulas by septum. This technique was indicated in the situation of large residual fistula in anterior part of palate which was divided into 2 fistulas by septum after bilateral cleft palate repair.

A Toolbox of Surgical Techniques for Palatal Fistula Repair

“…While this technique is not often employed for fistula repair, likely because of the requirement for 2 stages and the patient morbidity of tongue adhesion to the palate between the first and second stages, several reports have confirmed the feasibility and effectiveness of tongue flaps for large, complex fistulae lacking sufficient oral mucoperiosteal tissue (Sadhu, 2009; Murthy, 2011). In large palatal fistulae with little local tissue that is salvageable, tongue flaps are an ideal option because of their excellent vascularity, large tissue donor availability, and minimal donor site morbidity (speech impairment, taste, swallowing reflex; Vasishta et al, 2012; Mahajan et al, 2014; Zhou & Ma, 2019). Surgeons in the present study recommended that tongue flaps only be used if the patient will cooperate and would rarely use them before the age of 5 years.…”