Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study.

OBJECTIVES: To evaluate the effectiveness of regenerative tissue matrix (Alloderm) as an oral layer for difficult anterior palatal fistula closure. MATERIALS AND METHODS: The authors have tested the feasibility of a novel surgical technique of adding a regenerative tissue matrix (Alloderm) as an oral layer for closure of recalcitrant large anterior palatal fistulae and report the outcome of the first 12 patients in this pilot study. Patients with recurrent large fistula who otherwise would require either a local pedicled flap, free flap, or an obturator were treated with this technique and followed up for at least 6 months to monitor the progress of healing. RESULTS: Of the 12 patients, 8 patients (66.7%) had complete closure of the fistula, and 2 patients (16.7%) showed reduction in size of the fistula to the extent that symptoms were eliminated, for an overall success rate of 83.3% (10/12 patients). Premature graft loss and recurrence of the fistula were noted in 2 patients (16.7%). CONCLUSION: Alloderm provided an adequate barrier allowing healing to occur unimpeded and allowed closure of the palatal fistula. In our experience, this new technique using regenerative tissue matrix as an adjunct to the oral layer in large anterior palatal fistula has an advantage compared to other more invasive complex procedures and has been shown to provide satisfactory results.

Oral malignant melanoma: systematic review of literature and report of two cases.

OBJECTIVE: Oral malignant melanoma (OMM) is a rare tumor of the oral cavity with very poor prognosis despite the implementation of an aggressive treatment. This paper aims to shed some light on current evidence for management of OMM. STUDY DESIGN: We report 2 cases of OMM treated at our institute and a review of the literature in an endeavor to establish current understanding on various aspects of OMM. RESULTS: Both patients in our study are showing good local control with aggressive multimodal treatment. Long-term follow-up is needed to rule out distant metastasis. CONCLUSIONS: Because late diagnosis and advanced disease at the time of diagnosis are the only sure predictors of outcome, thorough clinical and pathologic workup of any suspected melanotic lesion should be carried out to diagnose OMM. Early diagnosis and aggressive multimodal treatment are the only means available to surgeons to provide better outcome to patients with OMM.