Rahpeyma Amin, Khajehahmadi Saeedeh
Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran; and Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
Plast Reconstr Surg Glob Open. 2015 Jan 8;2(12):e265. doi: 10.1097/GOX.0000000000000239. eCollection 2014 Dec.
Residual palatal fistula after repair of palatal cleft is common. Repair of residual oronasal fistula is not always successful. Two-layer closure techniques that close these fistulas with soft tissue are a common practice. Turnover flaps are the most used flaps and often the sole method for nasal-side closure of fistula. Anteriorly based inferior turbinate flap can be used to provide soft tissue for nasal-side closure when turnover flaps will not provide sufficient tissue for this purpose. Under general anesthesia with nasotracheal intubation, inferior turbinate was released from posterior attachment. After removing the inferior conchal bone, mucoperiosteal flap was used for nasal-side closure of anterior palatal fistula in patients with cleft. Anteriorly based inferior turbinate flap was used for nasal-side closure of residual palatal fistula in 3 patients with cleft. Age of the patients was 14, 16, and 18, and recurrence of palatal fistula has not occurred. Anteriorly based inferior turbinate flap is an axial pattern flap with appropriate surface of the paddle and vicinity to the oral cavity roof. It can be used in large anterior, palatal fistula for reconstruction of nasal floor. Considering appropriate another flap for oral side coverage of such fistula is mandatory.
腭裂修复术后残留腭瘘很常见。修复残留口鼻瘘并非总能成功。用软组织关闭这些瘘的双层闭合技术是常用方法。翻转瓣是最常用的瓣，通常也是瘘鼻腔侧闭合的唯一方法。当翻转瓣不能为此提供足够组织时，可使用带蒂下鼻甲瓣为鼻腔侧闭合提供软组织。在经鼻气管插管全身麻醉下，将下鼻甲从后部附着处游离。去除下鼻甲骨质后，将粘骨膜瓣用于腭裂患者前腭瘘的鼻腔侧闭合。3例腭裂患者使用带蒂下鼻甲瓣进行残留腭瘘的鼻腔侧闭合。患者年龄分别为14岁、16岁和18岁，腭瘘未复发。带蒂下鼻甲瓣是一种轴型瓣，其瓣叶表面合适且靠近口腔顶。它可用于较大的前腭瘘以重建鼻底。考虑为此类瘘的口腔侧覆盖选择合适的另一瓣是必要的。
