ABSTRACT
The closure of wide palatal clefts and recurrent oronasal fistulae may be challenging. After repeated failure of conventional techniques, microvascular tissue transfer may be indicated in the closure of such fistulae. Depending on the location and the size of the palatal fistula, different tissues are required to sufficiently close the palatal gaps. A subdivision of common flaps into mucosa, muscular, bony, skin, and fascia flaps was carried out to analyze their suitability for alveolar, hard, and soft palate reconstruction. Furthermore, the bulk of flaps and the length of the vascular pedicle were analyzed to rate the suitability of different flaps for palatal closure. Based on a new classification of oronasal fistulae, all these factors were taken into consideration to introduce a decision guidance of what microvascular flap fits a particular clinical situation. The radial free forearm flap was found to be sufficient in the closure of all classes of oronasal fistulae.
Subject(s)
Cleft Palate/surgery , Forearm/blood supply , Forearm/surgery , Oral Fistula/surgery , Plastic Surgery Procedures/methods , Surgical Flaps/blood supply , Humans , Microcirculation , Oral Fistula/classification , Treatment OutcomeABSTRACT
BACKGROUND: Carcinoma cuniculatum, a well-differentiated squamous cell carcinoma, is a rare neoplasm with a low risk of metastasis. METHODS AND RESULTS: A 74-year-old female patient is presented with a carcinoma cuniculatum of the right maxilla, a very rare variant of squamous cell carcinoma that usually occurs in the skin of the lower extremities, in particular, in the skin of the plantar surface of foot. It is described by an invasive growth pattern, but metastases to regional lymph nodes are rare. In the oral cavity, only very few cases have been published. CONCLUSION: The correct diagnosis of this entity with the knowledge that it is a variant of a low-grade carcinoma with low risk of metastasis is important, so that elective neck dissection must not be obligate.
