Ventrally based tongue flap for Palatal Fistula

Abstract

The palate fistula, which appears after an attempted closure of palate, usually becomes a headache for the surgeon. A large fistula of the palate may have very little tissue suitable for good closure, due to failure of previous attempts that normally increase the size of the defect and produces further scarring and impoverish vascularization. In these cases it would be useful to have a surgical alternative which is capable of providing good oral layer closure, especially when this technique provides adequate vascularized tissue, sufficient to cover the defect adequately and comfortably. In our service of Operación Sonrisa Ecuador, we have developed a modified technique taking the tongue as a source of tissue, (but different to that described by José Guerrerosantos), using the lower surface of the tongue, which is smooth, thin, and very well vascularized, taking advantage of reverse flow based on the contralateral deep lingual artery.

In our center, six surgeries were performed for patients having palatine fistula with several failed attempts of repair, from our service or similar, regardless of age, sex, or severity of the disease. These patients were evaluated with the speech therapy based on our speech scale (Alvarez Scale) in a preoperative phase and a month later in the postoperative phase. Based on the same parameters, we found an improvement from the functional point of view (speech and food regurgitation) in 92% of cases.