Intraoral anastomosis of a prelaminated radial forearm flap in reconstruction of a large persistent cleft palate

Abstract

In this report, we present a case of a prelaminated radial forearm flap in reconstruction of a large persistent cleft palate with transoral single arterial and three venous anastomoses. A 17-years-old female patient presented a large cleft palate defect and complete dentition, dysmelia of both arms and bilateral thumb aplasia. A radial flap was prelaminated using oral mucosa 5 days prior to transplantation. Five days after flap prelamination, the facial artery and vein, submandibular vein, and a venous branch to the masseter muscle behind the buccinator muscle fibers were exposed through an intraoral incision lateral to the inferior right mucogingival junction. The radial artery, its bilateral accompanying veins, and the cephalic vein of transplanted flap were anastomosed transorally to the facial vessels, submandibular vein, and masseter branch. The vessel pedicle ran through the palatoglossal arch dorsal to the second upper molar. Good flow and flap perfusion were evinced, and further-on successful healing was achieved. The case encourages similar treatment in comparable situations avoiding facial nerve hazard and extraoral scars.

Avoiding Facial Incisions with Midface Free Tissue Transfer

“…5,6,8 Additional case reports describe reconstruction of mandibular or palatal defects using free fibula flaps and anastomosis via an intraoral approach to the recipient facial vessels. 12,14,15 The patients described exhibit bony and soft-tissue defects arising from varied pathologies including oncologic, traumatic, and congenital defects demonstrating the applicability of this technique for a multitude of conditions.…”

“…There have also been no reported instances of facial nerve injury in these cases, likely relating to the more superficial anatomic location of the nerve when approached intraorally. 5,6,8,12,14,15,29 Our group did not use nerve monitoring to identify the facial nerve branch. Thus far, in our experience, we have found that the facial artery is commonly easier to identify because it is more anterior as compared to the facial vein, which is more posterior requiring deeper dissection.…”

Zygomatico-maxillary Reconstruction with Computer-aided Manufacturing of a Free DCIA Osseous Flap and Intraoral Anastomoses

“…23 Several reports of intraoral free flap anastomosis for a wide range of surgical indications and with a large variety of flaps followed and demonstrated favorable outcomes. 1,2,23–26 …”

A new method of sutureless microvascular anastomoses using a thermosensitive poloxamer and cyanoacrylate: An experimental study

“…We should consider the time we could save during surgical procedures, even if we cannot do without traditional and complete training of residents with conventional microsutures. Another benefit of this method could be the application to some awkward anastomoses like intraoral anastomoses …”

“…Another benefit of this method could be the application to some awkward anastomoses like intraoral anastomoses. 21 However, these results raise numerous questions. What are the limitations of this method of anastomosis?…”