You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: Tongue Flap Procedure for Palate Repair


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TONGUE FLAP PROCEDURE FOR PALATE REPAIR

Dr. John Canady

The tongue flap is a technique that is sometimes used to help repair a persistent fistula in the hard palate. Normally it is used after other measures (attempted re-repair, dermal fat graft, etc.) have not been able to get the fistula to close.  It can be based either on the front of the tongue or on the back of the tongue, depending upon where the hole in the palate is. (Connie Barone (plastic surgeon at the University of Missouri in Columbia, MO), gave a nice presentation on it at the ACPA meeting in Portland--I don't know if she ever published that or not.........). Its purpose is to allow new tissue to be brought into the area of the palate where there is a tissue shortage. I would not expect the taste buds on the tongue to continue to work in the palate, since the nerves to the flap have been disrupted in the tongue and the recipient site in the palate is innervated differently. Normally the tip and sides of the tongue (the most taste sensitive parts) are not incorporated into the flap and taste in the tongue itself is not severely affected.

The flap is left in place (attached to the tongue and the palate) for around 21 days and then the attachment to the tongue is taken down and the flap is inset into the palate, presumably now having a good blood supply from the surrounding palatal tissue.

Potential challenges with this procedure include:

1. The second anesthesia (for flap take down) usually is a challenge for the anesthesiologist--they have a child who cannot widely open their mouth and they (the anesthesiologist) do not have the airway control they are used to. This may require a sedated awake fiberoptic naso-tracheal intubation for the second step. This kind of anesthetic procedure is done routinely by trained pediatric anesthesiologists, but if the patient is unable or unwilling to cooperate, it can be technically difficult.

2. Actually, the kids do better than you might think with the flap in place in terms of eating, swallowing, etc. Anteriorly based flaps allow for a little more movement than posteriorly based flaps.

3. There is always the chance that the flap will not get enough blood supply from the surrounding palatal tissue. There is no good way to test for this prior to taking the flap down. (In the real old days of plastic surgery, there was a techique of "flap walking" to take skin from one body area to another by inserting one end and swinging the other end of a tubed flap around toward the recipient site.......these flaps were "trained" by compressing the original base and observing the color of the flap near the transferred end. If the flap did not turn dark blue, it was considered to have enough blood supply and the original base was divided. Obviously this is impractical inside the mouth.


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