Skip to main content

Advertisement

SpringerLink
Log in

Tongue flap: a “workhorse flap” in repair of recurrent palatal fistulae

  • Original Article
  • Published:
Oral and Maxillofacial Surgery Aims and scope Submit manuscript

Abstract

Aim and objective

A prospective study done to evaluate the efficacy of tongue flaps in secondary palatal defects, in terms of functionality, esthetics, and donor site morbidity, and to clarify the technique of elevating and insetting of tongue flap.

Materials and method

Twenty patients having recurrent secondary palatal fistula, post cleft treatment were treated with anteriorly and posteriorly based dorsal tongue flaps. Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and articulation, donor site morbidity, and esthetics.

Results

Twenty patients in age range of 11–24 years, with secondary palatal fistulae, were treated with anteriorly/posteriorly based tongue flap. There were two recurrences as the flap got detached in one patient and necrosis of flap in another. In other patients, healing was uneventful. The flap showed good success rate in terms of uptake and correction of oronasal regurgitation, with imperceptible donor site morbidity. With speech therapy assistance and periodic evaluation by a therapist, significant improvement in speech and articulation was noted over time in all successfully healed patients.

Conclusion

Use of tongue flap for repair of palatal fistulae is a successful technique as it provides appreciable quality and quantity of well-vascularized tissue for fistula closure with negligible functional and esthetic morbidity associated with donor site. As per our study, it is a reliable technique for palatal fistula closure. It even provides good speech improvement over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Pigott RW, Rieger FW, Frazer Moodie A (1984) Tongue flap repair of cleft palate fistulae. Br J Plast Surg 37:285–293

    Article  CAS  Google Scholar 

  2. Posnick JC, Getz SB (1987) Surgical closure of end stage palatal fistulas using anteriorly- based dorsal tongue flap. J Oral Maxillofac Surg 45:907–912

    Article  CAS  Google Scholar 

  3. Ogle OE (2002) The management of oronasal fistulas in the cleft palate patient. Oral Maxillofac Surg Clin N Am 14:553–562

    Article  Google Scholar 

  4. Awang MN (1988) Closure of oroantral fistula. Int J Oral Maxillofac Surg 17:110–115

    Article  CAS  Google Scholar 

  5. Buchbinder D, St-Hilaire H (2003) Tongue flaps in maxillofacial surgery. Oral Maxillofac Surg Clin N Am 15:475–486

    Article  Google Scholar 

  6. Steinhauser EW (1982) Experience with dorsal tongue flaps for closure of defects of the hard palate. J Oral Maxillofac Surg 40:787–789

    Article  CAS  Google Scholar 

  7. Cadenat H, Combelle R, Fabie M, Lambeaux de langue (1973) Vascularisation, morphologie et utilisation. Ann Chir Plast 18:223–227

    CAS  PubMed  Google Scholar 

  8. Bracka A (1981) The blood supply of dorsal tongue flap. Br J Plast Surg 34:379–384

    Article  CAS  Google Scholar 

  9. Shangkuan H, Xinghai W, Zengxing W et al (1998) Anatomic bases of tongue flaps. Surg Radiol Anat 20:83

    Article  CAS  Google Scholar 

  10. Kinnerbrew MC, Malloy RB (1983) Posteriorly based, lateral lingual flaps for alveolar cleft bone graft coverage. J Oral Maxillofac Surg 41:555–561

    Article  Google Scholar 

  11. Sweeney T, Sell D (2008) Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction. Int J Lang Commun Dis 43(3):265–282

    Article  Google Scholar 

  12. Smith TS, Schaberg SJ, Collins JT (1982) Repair of a palatal defect using a dorsal pedicle tongue flap. J Oral Maxillofac Surg 40:670–673

    Article  CAS  Google Scholar 

  13. Jackson IT, Fasching MC (1990) Secondary deformities of cleft lip, nose and cleft palate. In: JG MC, May JW Jr, Litter JW (eds) Plastic surgery, vol 4. Cleft lip and palate and craniofacial anomalies, chapt 56. Saunders, Philadelphia, p 2771

    Google Scholar 

  14. Lehman JA, Curtin P, Haas DG (1995) Closure of palatal fistulas. Oper Tech Plast Reconstr Surg 2:255–262

    Article  Google Scholar 

  15. Tessier P (1976) Anatomical classification of facial, craniofacial and laterofacial clefts. J Maxillofac Surg 4:69

    Article  CAS  Google Scholar 

  16. Denny AD, Amm CA (2005) Surgical technique for the correction of postpalatoplasty fistulae of the hard palate. Plast Reconstr Surg 115:383–387

    Article  Google Scholar 

  17. Abyholm FE, Borchgrevnik HH, Eskeland G (1979) Palatal fistulae following cleft palate surgery. Scand J Plast Reconstr Surg 13:295

    Article  CAS  Google Scholar 

  18. Schultz RC (1986) Management and timing of cleft palate fistulae repair. Plast Reconstr Surg 78:739

    Article  CAS  Google Scholar 

  19. Wilhelmi BJ, Appelt EA, Hill L, Blackwell SJ (2001) Palatal fistulas: rare with the two-flap palatoplasty repair. Plast Reconstr Surg 107:315–318

    Article  CAS  Google Scholar 

  20. de S. Amaratunga NA (1988) Occurrence of oronasal fistula in operated cleft palate patients. J Oral Maxillofac Surg 46:834–837

    Article  Google Scholar 

  21. Coghlan K, O’Regan B, Carter J (1989) Tongue flap repair of oro-nasal fistulae in cleft palate patients: a review of 20 patients. J Craniomaxillofac Surg 17:255–259

    Article  CAS  Google Scholar 

  22. Jackson IT (1972) Use of tongue flap to resurface lip defects and close palatal fistula in children. Plast Reconstr Surg 49:537–541

    Article  CAS  Google Scholar 

  23. Golden GT, Mentzer RM, Fox JW et al (1976) Basket suspension as an adjunct to tongue flap closure of hard palate defects. Cleft Palate J 13:350–353

    CAS  PubMed  Google Scholar 

  24. Sachs SA, Kay SA, Specter J et al (1979) Treatment of persistent oro-antral fistula with a posteriorly based lateral tongue flap. Int J Oral Maxillofac Surg 8(3):225–228

    CAS  Google Scholar 

  25. Abdollahi S, Jabbari Moghaddam Y, Rezan R et al (2008) Results of difficult large palatal fistula repair by tongue flap. Rawal Med J 33:56–58

    Google Scholar 

  26. Kim M-J, Lee J-H, Choi J-Y, Kang N, Lee J-H, Choi W-J (2001) Two-staged reconstruction of bilateral alveolar cleft using Y-shaped anterior-based tongue flap and ileac bone graft. Cleft Palate Craniofac J 38(5):432–437

    Article  CAS  Google Scholar 

  27. Jackson MS, Jackson IT, Christie FB (1976) Improvement in speech following closure of anterior palatal fistulae with bone graft. Br J Plast Surg 29:295

    Article  CAS  Google Scholar 

  28. Ceran C, Demirseren ME, Sarici M et al (2013) Tongue flap as a reconstructive option in intraoral defects. J Craniofac Surg 24(3):972–974

    Article  Google Scholar 

  29. Merriam-Webster Online Dictionary. www.merriam-webster.com (2019). Accessed 20 February 2019

Download references

Author information

Authors and Affiliations

  1. Identity ENT, Dental & Facial Surgery Center, Dehradun, India

    Nimish Gupta

  2. Department of Oral & Maxillofacial Surgery, J.S.S Dental College & Hospital, Mysore, India

    Nimish Gupta, Sujeeth Shetty & Saikrishna Degala

Authors
  1. Nimish Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sujeeth Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saikrishna Degala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nimish Gupta.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, N., Shetty, S. & Degala, S. Tongue flap: a “workhorse flap” in repair of recurrent palatal fistulae. Oral Maxillofac Surg 24, 93–101 (2020). https://doi.org/10.1007/s10006-019-00823-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10006-019-00823-9

Keywords

Search

Navigation