Tongue flap repair of oro-nasal fistulae in cleft palate patients

Single layer closure of palatal fistula using anteriorly based dorsal tongue flap

“…Various authors have described the advantages and disadvantages of dorsal tongue flap for the repair of palatal fistula [4][5][6][7]. Tongue flap closure for end-stage palatal defects is associated with a relative lack of complications and a high success rate in children and adults [4][5][6][7].…”

“…Even many authors have suggested single layer closure where ever feasible [9]. However, the importance of patient selection cannot be overemphasized while deciding between the surgical options of direct flap closure, anteriorly based dorsal tongue flap, or pedicled transantral temporalis muscle flap [1,2,7]. While using the anteriorly based tongue flap, the base should lie beneath the posterior border of the defect when the tongue is in its neutral position.…”

“…The flap should be thick enough to include several millimeters of muscle to protect the submucosal vascular plexus [2,3,[5][6][7]10,11]. The surgeon must not hesitate to raise a large flap (5-6 cm long, 1 cm thick) to ensure its vascular viability and allow considerable tongue movement without undue tension on the pedicle [4,7]. In addition, aggressive palatal shelf exposure around the defect allows both a watertight oral-side closure and an increased surface area for in growth of new blood vessels before flap division.…”

“…Although one hesitates to alter the tongue's anatomy for fear of changing speech or deglutition, these problems have not been noted [4,7]. Limitation of speach is encouraged to avoid undue tension on the pedicle [7].…”

Tongue flaps for reconstruction of the oral cavity

“…Dorsal flaps need to include 5 mm of muscle to protect the submucosal plexus. 20 We will discuss the advantages and disadvantages of the use of these flaps and the complications that may follow their use. We will also compare them with other reconstructive methods.…”