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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.
Subject(s)
Dental Fistula , Surgical FlapsABSTRACT
Oronasal fistulae (ONF) could remain after surgery in some patients with cleft palate. ONF ultimately requires intraoral surgery, which may lead to perioperative airway obstruction. Tongue flap surgery is a technique used to repair ONF. During the second surgery for performing tongue flap division, the flap transplanted from the tongue dorsum to the palate of the patient acts as an obstacle to airway management, which poses a great challenge for anesthesiologists. In particular, anesthesiologists may face difficulty in airway evaluation and patient cooperation during general anesthesia for tongue flap division surgery in pediatric patients. The authors report a case of airway management using a flexible fiberoptic bronchoscope during general anesthesia for tongue flap division surgery in a 6-year-old child.
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Child , Humans , Airway Management , Airway Obstruction , Anesthesia, General , Bronchoscopes , Cleft Palate , Fistula , Palate , Patient Compliance , TongueABSTRACT
La fístula palatina anterior es la comunicación anormal entre la cavidad oral y la nariz que se presenta después del cierre quirúrgico de la fisura palatina, ésta ocurre con más frecuencia en defectos de paladar duro. El colgajo de lengua está indicado para la reconstrucción de grandes fístulas palatinas y con excesivas cicatrices palatinas luego de varios procedimientos insatisfactorios. El colgajo ofrece varias ventajas ya que presenta abundante tejido, excelente irrigación y es de fácil rotación. El resultado fue satisfactorio.
The anterior palatal fistula is the abnormal communication between the oral cavity and nose that occurs after surgical closure of cleft palate, this occurs more frequently in hard palate defects. Tongue flap is indicated for the reconstruction of large fistulas and excessive palatal scars after several unsatisfactory procedures. The flap offers several advantages since it presents abundant tissue, excellent irrigation and easy rotation. The result was satisfactory.
Subject(s)
Humans , Child , Adolescent , Cleft Palate , Cleft Palate/surgery , Fistula/surgery , Palate, Hard/pathology , Surgical FlapsABSTRACT
Objective To introduce a modified surgical technique for repairing palate fistulae.Methods Based on the clinical categories of palate fistulae,local mucosal flap was designed,if possible,to reduce the area of the fistulae and reshape the fistulae.Then the thin tongue flap with anterior pedicle was designed for repairing the palate fistulae,without much limitation of tongue movement and excessive tension of tongue flap pedicle short lingual frenulum correction was performed firstly to release the motion of tongue,if necessary.The donor site was closed directly.Three weeks later division of the tongue flap,as well as detailed appearance correction of tongue,was carried out at the same time.Results 12 cases were treated,and followed up for 6-12 months.For all the cases,the defect of fistulae was totally repaired,while aesthetics appearance of tongue was satisfactory,and no interference with speech with the use of tongue as donor site.Oral hygiene and mastication were unimpaired.No patient described disability of sensory or gustatory postoperatively.Conclusions Tongue flap has sufficient blood supply,while impairment of donor site is minimal.The planning and procedure of surgery are relatively simple.It is an ideal flap in treatment of palate fistulae.
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Objective To evaluate the effect of olecranon osteotomy and triceps pedicel approach combined with ossylated triol in the treatment of humeral intercondylar fracture and its effect on prognosis. Methods Ninety-two patients with humeral intercondylar fractures were selected as study subjects. The patients were randomly divided into two groups: the study group and the control group. The study group selected the olecranon osteotomy for treatment. The control group selected brachial Triceps tongue tongue approach for treatment. Results The excellent and good rate of the study group was significantly higher than that of the control group (P<0.05). The mean time of operation and the time of fracture healing were significantly higher than those of the control group (P<0.05), and The data of PLT, ESR, CRP and RF in the two groups were significantly lower than those in the control group (P<0.05) , and the data of inflammatory indexes in the study group were significantly decreased (P<0.05).Conclusion The treatment of humeral intercondylar fractures with olecranon osteotomy combined with calcitriol has a direct effect. It can be seen that this treatment has a high value in clinical orthopedic treatment.
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Las fístulas oronasales son una de las secuelas más comunes consecutivas a la reparación quirúrgica del paladar hendido. El propósito de este reporte es presentar la experiencia con el uso de colgajos de lengua para el cierre de fístulas palatinas anteriores amplias (mayores de 1 cm) o con intentos quirúrgicos previos fallidos. El cierre de las fístulas palatinas anteriores mayores de 1 cm o con tratamientos previos sin éxito. Mediante colgajos de lengua es una de las opciones de tratamiento reportados en la literatura con un alto porcentaje de éxito. En este artículo presentamos un caso clínico de un paciente masculino de 23 años de edad con diagnóstico de secuelas labio y paladar hendido bilateral, que se presenta a la clínica de cirugía oral y maxilofacial de la división de estudios de postgrado e investigación, a la exploración intraoral presentaba una fístula palatina anterior de 2.5 cm de diámetro, con el antecedente de varios intentos quirúrgicos sin éxito, por lo que se decide realizar el cierre de la fístula palatina anterior con un colgajo de lengua de base anterior.
Oro-nasal fistulae are amongst the most common sequels after surgical repair procedures of cleft palate patients. The aim of the present study was to present the experience of using tongue flaps for closure of wide (over 1 cm) anterior palatal fistulae, or in those cases when surgery had previously failed. Closure with tongue flaps of anterior palatal fistulae larger than 1 cm, or when previous treatments have failed is one of the most successful treatment options reported in scientific literature. In the present article we introduce the case of a 23 year old male with bilateral cleft palate and lip surgery sequels. The patient attended the Maxillofacial and Oral Clinic of the Graduate and Research School. Intra-oral exploration revealed a 2.5 diameter anterior palatal fistula. The patient informed of a history of several failed surgical attempts; it was therefore decided to close the anterior palatal fistula with an anterior based tongue flap.
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The lips have important functional and esthetic facial features and the lips are used for relatively simple tasks, such as retaining oral contents, as well as for complex functions such as mastication, speech and expressing emotion. Therefore, it is esthetically and functionally critical to maintain the normal position and contour of the lips during reconstructive surgery. However, the freely movable nature of the vermilion and the cutaneous lip makes this area highly susceptible to distortion. We report here on a case of squamous cell carcinoma on the lower lip and the extensive surgical defect that resulted from total vermilionectomy and wedge resection of the lip was repaired with the tongue flap.
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Humans , Carcinoma, Squamous Cell , Lip , Mastication , TongueABSTRACT
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
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Humans , Fistula , Palate, Hard , Sutures , Tissue Donors , Tongue , Wounds and InjuriesABSTRACT
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Humans , Adipose Tissue , Cheek , Deglutition , Forearm , Free Tissue Flaps , Maxilla , Mouth Floor , Mucous Membrane , Neck Dissection , Oroantral Fistula , Palate , Phonation , Prognosis , Surgery, Oral , Surgical Flaps , Survival Rate , Tissue Donors , TongueABSTRACT
Small palatal fistulas following surgery for cleft palate can be corrected easily by local mucoperiosteal flap. But fistula repair is difficult if the fistula is large in hard palate. Tongue flaps are the most commonly used flaps for closure of difficult palatal fistulas. The authors treated 38 patients of large palatal fistulas using tongue flap. Among them, 33 patients were operated using posteriorly based tongue flap, and 5 patients were operated using anteriorly based tongue flap. In the former, all flaps were successfully survived and not necessary a fixation of tongue after flap transfer. But in the latter, tongue flap of a patient was detached because of high mobility, and tongue flap of a patient was necrotized because of poor blood supply. For closure of large palatal fistula, posteriorly based tongue flap is safer and more reliable technique than anteriorly based tongue flap considering mobility and blood supply.
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Humans , Cleft Palate , Fistula , Palate, Hard , TongueABSTRACT
Objective To study the reconstruction of lip defects by using lingual membrane flaps. Methods 11 cases were presented, whose lip defects were extensively or partially. According to the size of defects, bilateral and lateral lingual membrane flaps were transfered to cover the defects to rebuild the lip contour, and then the posteriors were cut 2 weeks later. The repair of lip defects were done after the cover of region outside of lip in 4 patients who had composite defects. 4 patients underwent bilateral lingual membrane flap for repair of lip defects over 1/2 width of lip. 7 patients whose lip defects were less than 1/2 width of lip underwent lateral lingual membrane flap for repair. Results all the flaps were survival. The contour, color and function of lips were reconstructed well. The feeling, taste and movement of the tongue were normal. Conclusion Using lingual membrane flap to close the large defect of lip requires only one operation, especially in the defect repair with bilateral lingual membrane flaps. The flaps can not only rebuild the lip color and contour, but also remain enough tongue papilla in order to ensure the tongue taste after the operation. The excision in the tongue is hidden and tongue's function and contour can be little affected.
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The micro-vascular architecture of the mucosa and submucosa of human tongue was studied under the surgical microscope and scanning electron microscope. The long branches of the profunda lingual arteries and the terminal branches of the dorsal lingual arteries anastomose into a thick layer of arterial network, under the mucosa and over the superficial muscle of the whole body and root of the tongue. Arteriolae spring from the submucosal arterial network, which get into the mucosa to form the capillary network of mucosa and the 9apillary plexuses of variant papillae.The relationship between the architecture of the lingual submucosal arterial network and the design of flaps, and the clinical significance of tongue diagnostic signs has been discussed.