Reconstruction of the wide palate defects with temporal osteocutaneous island flaps

Summary

The temporal osteocutaneous island (TOCI) flap was first performed in reconstruction of palatal defects by Furnas [8]. It consists of temporoparietal fascia, galea, pericranium and the cortical layer of parietal bone covered with pericranium. In this study, we present five patients with wide palatal defects treated by TOCI flaps. The causation of the wide palatal defects were gun-shot wounds in two patients and unsuccessful reconstruction of congenital cleft palate during early childhood in three patients. All patients were adult. TOCI flaps were performed in two stages. At first, the TOCI flap was elevated and covered with a split thickness skin graft. In the second stage (approximately 1.5 months later), the flap was elevated based on the superficial temporal artery as an island flap. It was then transferred to the palatal defect via a cheek tunnel and sutured to the edges of the defect. There was no need for bone fixation. The length of the pedicle of the flap was sufficient in size to easily reach the anterior part of the palate. No serious complications were seen. One minor oronasal fistula occurred; this was repaired by local flaps. The TOCI flaps improved speech only partially. In conclusion, we believe this procedure is a good method for reconstruction in wide palatal defects which need three layer closure. This procedure is not a satisfactory solution for complete correction of speech defects.