The Treatment of the Large Palatal Fistula Using the Tongue Flap

Kim, Seok Kwun; Moon, Joo Bong; Heo, Jeong; Kwon, Yong Seok; Lee, Keun Cheol

Abstract

INTRODUCTION: Most of the palatal fistulas develop along the suture line in a small size, so they can be corrected easily by re-palatoplasty or various flap surgery using the local mucoperiosteum. But it is very difficult to repair if the fistula is very large or located anterior to the hard palate. Buccal mucosal or vestibular mucosal flaps may settle the problems but there are many limitations on the size and location. And other extraoral distant flaps need not only many surgical steps but also cause inconvenience. But tongue flap proffers as an excellent method for the repair of large anterior palatal fistula because of highly mobility and rich blood supply and low donor site morbidity. MATERIALS & METHODS: We treated the six cases of large palatal fistulas using the distally based tongue flap. We dissected under the submucosa layer around fistula site preserving the mucoperiosteum and the elevated flap was rotated to nasal side and sutured with 4-0 Vicryl(R) for the repair of the nasal side. And then we elevated the tongue flap on the distal portion of the tongue. The elevated tongue flap was placed on the defect area and sutured with 4-0 Chromic(R). After 2 or 3 weeks, we detached the tongue flap which was placed on the fistula site. Donor site was closed with 4-0 Chromic(R).
RESULTS
The mean size of palatal fistula was 7.2 cm. All of patients complained the discomforts in masticating and speaking before flap detaching operation. A wound dehiscence was observed on tongue flap sutured to defect site. But it was healed by revisionary suture. There was no donor site complication.
CONCLUSION
The authors propose that the distally based tongue flap is an excellent method for the repair of large palatal fistula because of its highly mobility, rich blood supply, and few of donor site morbidit