Reconstruction of persistent oronasal communication using an anteriorly based tongue flap following failed cleft palate repair—Report of two cases

Abstract

The tongue flap is a suitable alternative to local mucoperiosteal flaps in closure of wide, persistent oronasal communications, surrounded by scarred and fibrotic tissue as a result of previously attempted palatoplasty. Herein, we report two cases with large recurrent oronasal communication closed using the anteriorly based dorsal tongue flap. K E Y W O R D Sdorsal tongue flap, failed cleft palate repair, persistent cleft palate, persistent oronasal communication, tongue flaps How to cite this article: Guthua S, Sarna K, Kamau M, Ng'ang'a PM. Reconstruction of persistent oronasal communication using an anteriorly based tongue flap following failed cleft palate repair-Report of two cases.

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis

“…In a recent review by Saothonglang [17 ▪▪ ], cleft width, and association with defined clinical and genetic syndromes, were significant predictive factors for development of postoperative fistulae. Oronasal fistula recurrence is consistently higher in patients with large oronasal fistulas repaired using local mucoperiosteal flaps alone when compared to repairs incorporating additional regional flaps or free flap tissue transfer [18]. Tension along the palate repair lines, avascular necrosis of the flaps from presumed pedicle injury, postoperative infection, and delayed wound healing have been significantly associated with fistula recurrence [18,19].…”

“…In the interval period where the dorsal tongue flap is attached, however, significant airway concerns remain and intubation is extremely challenging. Overall success rates range from 85% to 95.5% [18,43,44].…”

“…Tongue flaps require a two-staged procedure involving the division of the pedicle after 3 weeks, leading some clinicians to consider distant flaps as a safer, more practical, alternatives where they are available [40]. Despite these considerations, the tongue flap remains an useful component of the cleft surgeon's armamentarium for the treatment patients with persistent, particularly anterior, palatal defects, especially when other less morbid approaches have proven ineffective [18].…”

“…Despite being highly effective in closing fistulae when employed, tongue flaps have significant drawbacks such as airway and intubation concerns, dysarthria, significant pain at the donor site, the inherent multistage operative protocols, and the significant possibility of nasogastric tube feeding postsurgery (at least short-term), making them less than ideal. Complications associated with this method include hematoma, sloughing, epistaxis, dehiscence due to tongue movement, narrowing of the tongue, and most of all, significant airway concerns caused by tethering the tongue to the roof of the mouth [18,42 ▪ ,43].…”