Jeyaraj Colonel Priya
Command Military Dental Centre (Northern Command), Udhampur, Jammu and Kashmir India.
J Maxillofac Oral Surg. 2018 Jun;17(2):175-181. doi: 10.1007/s12663-017-1035-6. Epub 2017 Jul 18.
Despite the improvement in surgical techniques in cleft palate surgery, oronasal fistulas continue to remain a challenge, usually the result of residual palatal and alveolar clefts and post-palatoplasty defects. The tongue flap is an extremely versatile, sturdy, reliable and efficient means of closure of anterior as well as posterior, unilateral and bilateral palatal defects, effectively functionally obliterating the oronasal communication, owing much of its success to its highly vascular structure, good mobility, texture match, central location and low donor site morbidity. However, it has a few drawbacks. Flap dehiscence and detachment during the early postoperative period is a troublesome complication owing to tongue movements during normal activities such as speaking, swallowing, yawning and coughing.
This article describes some of the methods which can be used to effectively alleviate these shortcomings.
A protocol of immobilizing the tongue by tethering it to the maxillary teeth for the 3-week postoperative period, and also maintaining the patient on nasogastric feeding, until the patient is taken up for surgical separation the pedicle, was employed in all patients in this case series.
There was a successful and predictable take of the tongue flap at the donor site, namely the palatal/oronasal fistula with its successful closure, in all the patients.
Treatment of the oronasal fistula using a two-layer closure using the nasal mucoperiosteum together with an anteriorly based dorsal tongue flap is an easy and efficient method, whose reliability can be further increased by avoiding a common complication, namely tongue 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 3-week postoperative period.
尽管腭裂手术的外科技术有所改进，但口鼻瘘仍然是一个挑战，通常是腭部和牙槽嵴裂残留以及腭裂修复术后缺损的结果。舌瓣是一种极其通用、坚固、可靠且有效的方法，可用于闭合前部和后部、单侧和双侧腭部缺损，有效地在功能上消除口鼻通道，其成功很大程度上归功于其高度血管化的结构、良好的活动性、质地匹配、中央位置以及较低的供区发病率。然而，它也有一些缺点。术后早期舌瓣裂开和脱离是一个麻烦的并发症，这是由于在说话、吞咽、打哈欠和咳嗽等正常活动中舌头的运动所致。
本文描述了一些可用于有效缓解这些缺点的方法。
本病例系列中的所有患者均采用了一种方案，即在术后3周将舌头拴系在上颌牙齿上以固定舌头，并维持患者鼻饲，直到患者接受蒂部手术分离。
所有患者的供区即腭部/口鼻瘘处的舌瓣均成功且可预测地成活，并成功闭合。
使用鼻黏膜骨膜和基于前部的舌背瓣进行双层闭合治疗口鼻瘘是一种简单有效的方法，通过避免常见并发症，即术后因舌头运动导致舌瓣脱离，将舌头拴系在上颌牙齿上固定舌头，并在术后3周维持患者鼻饲，可进一步提高其可靠性。
