Versatility of Tongue Flaps for Closure of Palatal Defects- Case Report

Abstract

A 72-year-old female patient reported to the Department of Oral and Maxillofacial Surgery, with a chief complaint of growth over the upper left back tooth region since one month. She noticed the growth as a small mass that progressively enlarged in size and it was associated with pain from the past one week. The pain was intermittent, moderate in intensity and relieved by analgesics. On examination, there was no obvious facial swelling. Intraoral examination revealed a swelling of 4x3 cm in diameter soft in consistency with irregular edges around maxillary left second and third molars covering up to the middle thirds of crown of these teeth. The growth showed red and white areas and was tender on percussion. The patient was advised for routine blood investigation and Computed Tomography (CT) scan. CT report showed a lesion with greatest dimension of 7x5 cm involving the left posterior maxilla and maxillary sinus with ill-defined granular bone periphery. Internally the lesion showed evidence of large hypodense and hyperdense areas with thin trabecular pattern and thin separations within the lesion. Roots of second molars showed areas of resorption. The medial, superior and posterior lateral walls of the left maxillary sinus were intact. An incisional biopsy was taken from the first molar region and was sent for histopathological examination. The microscopic examination showed parakeratinized stratified squamous epithelium which appeared hyperplastic and underlying connective tissue showed dense chronic inflammatory cell infiltrate, chiefly lymphocytes. The deeper connective tissue showed dis persed multinuclear giant cells in association with vesiculated mononuclear cells with moderate vascularity. The histopathological report confirmed the mass as central giant cell granuloma. A subtotal maxillectomy was planned for the patient. Written informed consent was obtained from the patient. Patient was prepared and draped under orotracheal intubation. Weber Ferguson incision was made through the skin and subcutaneous tissue. Upper lip was divided through its full thickness upto gingival labial sulcus and incision was extended sublabially along the mucobuccal fold upto the tuberosity. The subciliary component was extended preseptally. A subperiosteal cheek flap was then elevated from the maxilla. The maxilla was fully exposed and a subtotal maxillectomy was performed removing the tumour in toto [Table/ Fig-1]. As the primary closure of the defect couldn't be made during the surgery, a preoperatively fabricated obturator was placed and stabilized to the cheek flap using 3-0 ethilon suture. Postoperative period of the patient was uneventful. Patient was kept under observation for one year.One year follow up showed a reduction in the size of defect to about 2x3 cm, then a posteriorly based tongue flap was planned to close the oroantral fistula. Written informed consent was taken from the patient. Patient was prepared and draped under nasotracheal intubation. De-epithelization was done around the oroantral fistula. A poster...

Rotación de colgajo lingual para cierre de fístula palatina en pacientes con labio y paladar fisurados realizado en el Hospital Municipal de la Mujer y el Niño, Cuenca, Ecuador

“…1,8 Similar results were found in the research of Guerrero Santos et al, 1,3 in their study they showed a 70% success rate of the therapy by using anteriorly based lingual flaps, similar data was observed in the study of Pigott with a success rate of 85% using the anteriorly based lingual flap surgical technique. 1,3 Due to the multiple failures and attempts to achieve the closure of a palatal fistula, Guerrero-Santos and Altamirano et al 7,9 1966, were the first to report the use of a lingual flap for the closure of palatal fistulas, due to its good vascularization and excellent esthetic and functional results, in this research a similar success to the one described in the mentioned study was obtained. 7,9 Nawfal et al 7 in their research in 2014 referred in their therapies a correct closure of palatal fistula using the lingual flap technique.…”

“…1,3 Due to the multiple failures and attempts to achieve the closure of a palatal fistula, Guerrero-Santos and Altamirano et al 7,9 1966, were the first to report the use of a lingual flap for the closure of palatal fistulas, due to its good vascularization and excellent esthetic and functional results, in this research a similar success to the one described in the mentioned study was obtained. 7,9 Nawfal et al 7 in their research in 2014 referred in their therapies a correct closure of palatal fistula using the lingual flap technique. 7 Alsalman et al 8,10 2016 demonstrated success in the surgical procedure based on lingual flap because the acceptance of the therapy was 100% in the cases that www.medigraphic.org.mx were submitted to this surgical intervention; similar results showed this research where 100% success was obtained in the cases submitted to the lingual flap rotation technique.…”

“…1,8 Resultados similares se encontraron en las investigaciones de Guerrero Santos y colaboradores, 1,3 en su estudio manifestaron 70% de éxito de la terapia mediante el uso de colgajos linguales con base anterior, datos semejantes se observaron en el estudio de Pigott con un éxito de 85% empleando la técnica quirúrgica de colgajo lingual de base anterior. 1,3 Debido a los múltiples fracasos e intentos para lograr el cierre de una fístula palatina, Guerrero-Santos y Altamirano y su grupo, 7,9 en el año 1966, fueron los primeros en reportar el uso de colgajo lingual para el cierre de fístulas palatinas, por su buena vascularización y excelentes resultados estéticos y funcionales, en esta investigación se obtuvo éxito similar al descrito en el estudio mencionado. 7,9 Nawfal y colegas 7 en su investigación en el año 2014 refirieron en sus terapias un correcto cierre de fístula palatina empleando la técnica de colgajo lingual.…”

“…1,3 Debido a los múltiples fracasos e intentos para lograr el cierre de una fístula palatina, Guerrero-Santos y Altamirano y su grupo, 7,9 en el año 1966, fueron los primeros en reportar el uso de colgajo lingual para el cierre de fístulas palatinas, por su buena vascularización y excelentes resultados estéticos y funcionales, en esta investigación se obtuvo éxito similar al descrito en el estudio mencionado. 7,9 Nawfal y colegas 7 en su investigación en el año 2014 refirieron en sus terapias un correcto cierre de fístula palatina empleando la técnica de colgajo lingual. 7 Alsalman y su grupo, 8,10 en 2016 demostraron éxito en el procedimiento quirúrgico a base de colgajo lingual debido a que la aceptación de la terapia fue del 100% en los casos que fueron sometidos a esta intervención quirúrgica; resultados semejantes mostró esta investigación donde se obtuvo éxito del 100% en los casos sometidos a la técnica de rotación de colgajo lingual.…”

New Tunneled Buccal Fat Pad Flap for Palatal Reconstruction

“…Various techniques have been suggested for the coverage of palatal defect which include secondary healing, local flap such as buccal advancement flap, palate rotation flap, tongue flap, or combined buccal and palate double layered closure flap, pedicled BFP. 8,[10][11][12] Microvascular free flaps have also been described for a medium-sized defect however the invasiveness of procedure, operative time and morbidity do not recommend their use. 13 Since introduction of the buccal fat pad for reconstruction of maxillary defect in 1977, 4 most studies have described the highly successful of the BFP in the reconstruction of different oral defect after tumor resection.…”