Jeyaraj Priya Esther
Command Military Dental Centre (Northern Command), Udhampur, Jammu and Kashmir, India.
Ann Maxillofac Surg. 2017 Jul-Dec;7(2):180-187. doi: 10.4103/ams.ams_94_17.
Residual defects of the palatal region following ablative resection of tumors and Gunshot wounds (GSWs) of the maxillofacial region can be quite painstaking, daunting and challenging to reconstruct, due to the extent and composite nature of the tissue loss. A shortage of available donor areas and local flap options in the intraoral region, add to the difficulty. Further compounding the situation, are factors such as excessive fibrosis and scarring of the palatal tissues as a result of multiple previous surgeries in the region.
To evaluate the effectiveness of the Dorsal Pedicled Tongue Flap in the reconstruction of complex palatal defects resulting from maxillofacial GSWs and ablative tumor resections. To also device techniques to reduce the incidence of postoperative tongue flap detachment, thus improving its efficiency and reliability.
The palatal fistulas in all the patients were closed successfully, with no post-operative complications such as bleeding, hematoma formation, congestion, infection, partial or total flap necrosis or flap detachment. The tongue flap at the recipient site remained healthy with no recurrence of the fistula in any of the patients in the two years follow up period. There was a complete resolution of the problem of nasal regurgitation of orally ingested fluids and food particles. There was observed no deformity or articulation defect resulting from the flap harvested from the tongue dorsum, in any of the patients.
In GSWs and tumor ablative surgery, where composite tissue defects are involved, the tongue provides a reliable and efficient means of restoring lost tissue bulk as well as ensuring a permanent closure and sealing off of the oronasal fistulas. Its reliability can be further increased by avoiding a common complication, namely, flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also, maintaining the patient on Nasogastric feeding for the three weeks postoperative period, until the patient is taken up for surgical separation the pedicle. This helps to ensure a successful and predictable take of the flap at the donor site.
由于肿瘤切除术后腭部区域的残余缺损以及颌面部枪伤（GSW）导致的组织缺损范围和复合性质，重建工作可能会非常艰巨、令人生畏且具有挑战性。口腔区域可用供区和局部皮瓣选择的短缺，增加了难度。该区域多次先前手术导致的腭部组织过度纤维化和瘢痕形成等因素，使情况更加复杂。
评估背侧带蒂舌瓣在重建颌面部枪伤和肿瘤切除术后复杂腭部缺损中的有效性。同时设计技术以降低术后舌瓣脱离的发生率，从而提高其效率和可靠性。
所有患者的腭瘘均成功闭合，无术后并发症，如出血、血肿形成、充血、感染、部分或全部皮瓣坏死或皮瓣脱离。在两年的随访期内，接受部位的舌瓣保持健康，所有患者均未出现瘘管复发。口服液体和食物颗粒鼻反流问题完全解决。在任何患者中，均未观察到因从舌背获取皮瓣而导致的畸形或发音缺陷。
在涉及复合组织缺损的枪伤和肿瘤切除手术中，舌头提供了一种可靠且有效的方法来恢复丢失的组织量，并确保永久性关闭和封闭口鼻瘘。通过避免常见并发症，即术后因舌头运动导致的皮瓣脱离，将舌头系在上颌牙齿上使其固定，并在术后三周内维持患者鼻饲，直到患者接受蒂部手术分离，可进一步提高其可靠性。这有助于确保皮瓣在供区成功且可预测地存活。
