Closure of Oronasal Fistulae Post Palatoraphy with Tongue Flap in Bilateral Complete Cleft Lip Palate Patient: A Case Report

ABSTRACT@#Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy. Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported. Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful, and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.

Comparação entre os retalhos microcirúrgicos antebraquial e lateral do braço em reconstruções de boca e orofaringe / Comparison between the forearm and lateral arm flaps for microsurgical reconstruction of the oral cavity and oropharynx

Introdução: A reconstrução microcirúrgica de tecidos moles após ressecção de neoplasias de boca e orofaringe tem impacto significativo na qualidade de vida do paciente. Dois retalhos freqüentemente utilizados são o antebraquial e o lateral do braço. Objetivo: Comparar a evolução do leito receptor e da área doadora em pacientes submetidos a um desses dois retalhos. Pacientes e Método: Estudo retrospectivo com análise de 31 pacientes submetidos aos retalhos previamente descritos. Resultados: Houve predomínio do gênero masculino (56%). A idade média foi de 56,5 anos. Vinte e dois pacientes (71%) foram submetidos à reconstrução com retalho lateral do braço. Houve diferença significativa no tempo de uso de sonda naso-enteral (p=0,037) e no tipo de fechamento da área doadora do retalho (p<0,001). Discussão: Os retalhos, apesar de similares, têm indicações distintas em nosso serviço. Consideramos o retalho lateral do braço como primeira escolha para reconstrução de defeitos de tamanho médio de tecidos moles em boca e orofaringe. Conclusão: Consideramos que os retalhos antebraquial e lateral do braço são seguros e adequados para reconstrução de boca e orofaringe.

Introduction: the microsurgical reconstruction of soft tissues after ablative surgery of oral cavity/oropharynx neoplasms impacts on the patients´ quality of life. Two frequently used options are the forearm and the lateral arm flaps. Objective: to compare the evolution of the receptor and donor sites. Patients and Methods: retrospective study of 31 patients submitted to one of the previously mentioned flaps. Results: Most patients were male (56%). The mean age was 56.5 years old. Twenty-two patients (71%) underwent the reconstruction using the lateral arm flap. There was a statistically significant difference in the duration of enteral tube use (p=0.037) and the closure of the donor area (p<0.001). Discussion: although similar, the flaps have distinct indications in our service. We consider the lateral arm flap as the first choice in medium sized soft tissue defects of the oral cavity/oropharynx region. Conclusion: We consider both flaps to be reliable and adequate for oral cavity/oropharynx reconstruction.

Intraoral Reconstruction with Buccinator Myomucosal Flap

Since the buccinator myomucosal flap was first described, it has been modified, with the study of anatomical model. Therefore, buccinator myomucosal flap can be elevated in various direction according to defect with its sufficient arc of rotation. With the buccinator myomucosal flap, intraoral reconstruction was performed in 3 patients. Two adult patients were suffered from complete cleft palete. Partial tongue reconstruction was performed in another patient following partial glossectomy due to tongue cancer. Satisfied results were obtained in all three patients. In these cases, the author designed flaps in island patterns. It would be more helpful to close donor site primarily and obtaining free rotation arc. The pedicle was located in retromolar trigone, flap detachment was not needed. Considering the disadvantages of other reconstruction methods, such as contracture, hair growth and poor oral hygiene caused by skin graft or conventional free flap, the buccinator myomucosal flap would be another good option for intraoral reconstruction with "like tissue".

Versatile Use of Buccinator Myomucosal Flap for Oral Cavity and Orbital Reconstruction

This paper represents the versatility of buccinator myomucosal flap for intraoral and orbital reconstruction of mild to moderate defect and we introduce recontructive methods are introduced along with our clinical experience. Buccal artery from internal maxillary artery is the main arterial pedicle, and buccal branch from facial artery also can supply blood for the buccinator muscle. The abundant blood flow from interconnected pedicles supports the reliable circulation of the buccal mucosa. So we could reconstruct the eye socket using reversed island buccinator myomucosal flap based on the angular vessel. The motor innervation of the buccinator muscle comes from the facial nerve. The buccinator muscle is considered to be a part of the sphincteric muscular system involving the functions of sucking, whistling, propelling food during mastication and voiding the buccal cavity. From 1990 to 1999, the flap was utilized in 8 patients to reconstruct the small to moderate intraoral defect and 1 patient for orbital mucosal defect. All flaps survived completely. There has been no flap necrosis and fistula. The results have been functionally and esthetically satisfactory. It is very reliable and safe flap with a minimal morbidity of donor site. It doesn't require microsurgical technique. Rapid healing may be achieved with its mucosal nature. We conclude that buccinator myomucosal flap can be widely used with a lot of advantages for intraoral and orbital defect because of its many advantages.

The cervical island flap for intraoral reconstruction following excision of oral cancer: report of 3 cases