Oronasal Fistula Closure with Tongue Flap: A Case Report

Authors

  • Pawee Kawila

Keywords:

cleft lip and palate, oronasal fistula, tongue flap

Abstract

Oronasal fistula could remain after palatoplasty in some patients with cleft lip - palate. Repairing large oronasal fistula in such case could be challenging. Repairing with local mucoperiosteal flap is usually difficult and unsuccessful. Tongue flap could be used to reconstruct this type of defect because of its abundant vascularity and the low morbidity associated with its use. The author reported a case of a 9-year 7-month-old Thai girl cleft lip with cleft palate patient with history of repaired cleft lip and palate, came with a problem of a large anterior oronasal fistula underwent fistula closure with anteriorly based tongue flap. The patient underwent tongue flap division surgery under general anesthesia three weeks after the first surgery. After the surgery, the recipient site showed good healing. The appearance and function of donor site were within normal limits. In conclusion, the use of the tongue flap demonstrated a good choice of reconstruction option in this type of defect. Yet, a proper flap design, a good surgical technique and a good postoperative care determined the success of the treatment. Performing tongue flap division in the second surgery was an exclusive challenge for anesthesiologist in airway management during general anesthesia because the oral cavity was obscured by the flap. Thus, planning of airway management after thorough consultation between anesthesiologist and surgeon before operation is vital.

References

Posnick JC,Getz SB. Fistulas Using Anteriorly-Based Dorsal Tongue Flaps.1987;907–12.

MUSGRAVE RH, BREMNER JC. COMPLICATIONS OF CLEFT PALATE SURGERY. Plast Reconstr Surg [Internet]. 1960;26(2). Available from: https://journals.lww.com/plasreconsurg/Fulltext/1960/08000/COMPLICATIONS_OF_CLEFT_PALATE_SURGERY.3.aspx

Vasishta SMS, Krishnan G, Rai YS, Desai A. The Versatility of the Tongue Flap in the Closure of Palatal Fistula. Craniomaxillofac Trauma Reconstr. 2012;5(3):145–59.

Cohen SR, Kalinowski J, LaRossa D, Randall P. Cleft Palate Fistulas: A Multivariate Statistical Analysis of Prevalence, Etiology, and Surgical Management. Plast Reconstr Surg [Internet]. 1991;87(6). Available from: https://journals.lww.com/plasreconsurg/Fulltext/1991/06000/Cleft_Palate_Fistulas__A_Multivariate_Statistical.5.aspx

Israel A, Partida G. Reconstruction of anterior palatal stula. 2016;20(1):50–6.

Rahpeyma A, Khajehahmadi S. Closure of huge palatal fistula in an adult patient with isolated cleft palate: A technical note. Plast Reconstr Surg - Glob Open. 2015;3(2):1–3.

Schultz RC. Management and Timing of Cleft Palate Fistula Repair. Plast Reconstr Surg [Internet]. 1986;78(6). Available from: https://journals.lww.com/plasreconsurg/Fulltext/1986/78060/Management_and_Timing_of_Cleft_Palate_Fistula.4.aspx

Buchbinder D, St-Hilaire H. Tongue flaps in maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2003;15(4):475–86.

Shetty R, Lamba S, Gupta AK. Role of facial artery musculomucosal flap in large and recurrent palatal fistulae. Cleft Palate-Craniofacial J. 2013;50(6):730–3.

van der Wal KGH, Mulder JW. The temporal muscle flap for closure of large palatal defects in CLP patients. Int J Oral Maxillofac Surg. 1992;21(1):3–5.

Parhiscar A, Har-El G, Turk JB, Abramson DL. Temporoparietal osteofascial flap for head and neck reconstruction. J Oral Maxillofac Surg. 2002;60(6):619–22.

Rahpeyma AR, Khajehahmadi SK, Nakhaei M. Submental artery island flap in reconstruction of hard palate after wide surgical resection of verruccous carcinoma, two case reports. Iran J Otorhinolaryngol. 2013;25(72):177–81.

Christiano JG, Dorafshar AH, Rodriguez ED, Redett RJ. Repair of recurrent cleft palate with free vastus lateralis muscle flap. Cleft Palate-Craniofacial J. 2012;49(2):245–8.

Deleyiannis FWB, Phil M, Haralam MA, Naran S, Worrall CI, Dudas JR, et al. The Pittsburgh Fistula Classification System : A Standardized Scheme for the Description of Palatal Fistulas. 2006;

Taylor HO, Sullivan SR. Alveolar bone grafting [Internet]. Global Reconstructive Surgery. Elsevier Inc.; 2018. 176–181 p. Available from: https://doi.org/10.1016/B978-0-323-52377-6.00022-7

Strauss RA, Kain NJ. Tongue Flaps. Oral Maxillofac Surg Clin North Am [Internet]. 2014;26(3):313–25. Available from: http://dx.doi.org/10.1016/j.coms.2014.05.002

Zeidman A, Lockshin A, Berger J, Gold B. Repair of a chronic oronasal defect with an anteriorly based tongue flap: Report of a case. J Oral Maxillofac Surg. 1988;46(5):412–5.

Siegel EB, Bechtold W, Sherman PM, Stoopack JC. Pedicle tongue flap for closure of an oroantral defect after partial maxillectomy. J Oral Surg. 1977 Sep;35(9):746–8.

von Domarus H. The double-door tongue flap for total cheek mucosa defects. Plast Reconstr Surg. 1988 Aug;82(2):351–6.

Calamel PM. The median transit tongue flap. Plast Reconstr Surg. 1973 Mar;51(3):315–8.

Schaberg SJ, Collins JT. Repair of a Palatal Defect Using a Dorsal Pedicle Tongue Flap. 1978;670–3.

Zeki Guzel M, Altintas F. Repair of Large, Anterior Palatal Fistulas Using Thin Tongue Flaps: Long-Term Follow-up of 10 Patients. Istanbul, Turkey: Annals of Plastic Surgery; 2000. p. 109–14.

Assunçao AG. The design of tongue flaps for the closure of palatal fistulas. Plast Reconstr Surg. 1993;91(5):806–10.

Kim YK, Yeo HH, Kim SG. Use of the tongue flap for intraoral reconstruction: A report of 16 cases. J Oral Maxillofac Surg. 1998;56(6):716–9.

Kim MJ, Lee JH, Choi JY, Kang N, Lee JH, Choi WJ. Two-stage reconstruction of bilateral alveolar cleft using Y-shaped anterior-based tongue flap and iliac bone graft. Cleft Palate-Craniofacial J. 2001;38(5):432–7.

Solan KJ. Nasal intubation and previous cleft palate repair. Anaesthesia. 2004;59(4):923–4.

Hopkins JD, Jackson IT, Smith AW, LeVasseur F. Large tongue flaps to close massive palatal defects. Eur J Plast Surg. 1999;22(8):387–93.

Johnson PA, Banks P, Brown AE. Use of the posteriorly based lateral tongue flap in the repair of palatal fistulae. Int J Oral Maxillofac Surg. 1992;21(1):6–9.

Sherry P, Pramod S, Jerry P. Airway Management During Second-Stage Tongue Flap Procedure. 2007 p. 216–7.

Sahoo TK, Ambardekar M, Patel RD, Pandya SH. Airway management in a case of tongue flap division surgery: a case report. Indian J Anaesth [Internet]. 2009;53(1):75–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20640083

So E, Yun HJ, Karm MH, Kim HJ, Seo KS, Ha H. Airway management in pediatric tongue flap division for oronasal fistula closure: A case report. J Dent Anesth Pain Med. 2018;18(5):309.

Kuroiwa KK, Nishizawa M, Kondo N, Nakazawa H, Hirabayashi T. Remifentanil for sedation and analgesia during awake division of tongue flap in children: a report of two cases. JA Clin Reports. 2017;3(1):2–5.

Downloads

Published

2023-02-15

How to Cite

1.
Kawila P. Oronasal Fistula Closure with Tongue Flap: A Case Report. Nakhonphanom Hosp J [internet]. 2023 Feb. 15 [cited 2026 Jan. 26];10(1):e261697. available from: https://he01.tci-thaijo.org/index.php/nkpjournal_9/article/view/261697

Issue

Vol. 10 No. 1 (2023): ่๋๋๋JANUARY - APRIL 2023

Section

Original article

License

Copyright (c) 2023 Nakhonphanom Hospital Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

  1. บทความที่ได้รับการตีพิมพ์ถือเป็นลิขสิทธิ์ของ โรงพยาบาลนครพนม
  2. ข้อความหรือข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความนั้นๆ ไม่ใช่ความเห็นของกองบรรณาธิการ