Tongue Flap for Closure of Complex Oronasal Fistula

Abstract

Complex oronasal fistula is one of the most frequent secondary complications of cleft palate correction and is considered a reconstructive challenge. Tongue flaps are one of the procedures for the treatment of complex fistulas associated or not with multiple previous procedures, offering a high success rate, few complications, and problems during its development. This study evaluates the efficacy in terms of functionality, esthetic, donor area morbidity and clarifies surgical technique steps. Descriptive cohort study was performed between August 2011 to August 2021 where an anteriorly based dorsal tongue flap was performed in 30 patients with complex palatal fistulas, evaluating outcomes in terms of technique reproducibility and flap viability, correction of oronasal regurgitation, speech, donor site morbidity, complications, and esthetics. The senior author has used this technique with consistent clinical outcomes to improve complex oronasal fistula with minimal complications, with a good success rate in terms of correction of the palatal defect with imperceptible alteration of the lingual donor area. In addition, establishes a specific definition of persistence and recurrence of oronasal fistula. The tongue flap is considered the gold standard in complex oronasal fistula reconstructions with satisfactory outcomes, and it offers an adequate amount of vascularized tissue achieving fistula closure without functional or esthetic impairment of the donor area and is a highly reproducible technique.

Oronasal Fistula Closure and Defect Reconstruction: Two Case Reports Using Periodontal Plastic Surgery Principles

“…Third, the number of interventions required could range from 2 to 3, with maximum surgeries including inner closure of the communication using connective tissue grafts, guided bone regeneration, and a free gingival graft for the final improvement of the phenotype. Finally, this approach directly addresses the final aesthetic desires of patients, aligning with their aesthetic goals and improving overall satisfaction (Kim and Seo 2023 ; Meneses Argalle, Espinosa Orozco, and Prada Madrid 2023 ; Obermeyer et al 2022 ; Zielinska‐Kazmierska et al 2021 ).…”