Closure of postoperative palatal defects using a thin mucosal tongue flap

Relevance. Congenital cleft lip and palate is a severe craniofacial malformation that requires long-term, multistage treatment. Palatal defects are among the most common sequelae following uranoplasty, and their closure is often complicated by the presence of scar tissue in the surgical site. One of the techniques used for palatal defect reconstruction involves a pedicled tongue flap.

Materials and methods. From 1998 to 2024, a total of 236 pediatric patients aged 6 to 18 years with a diagnosis of hard palate defect were treated at the Department of Pediatric Maxillofacial Surgery. All patients underwent closure using a modified pedicled tongue flap—a thin mucosal flap. The surgical approach was adapted based on the size, shape, and configuration of the defect. During the first stage, a thin mucosal flap was harvested from the tongue and secured to the margins of the defect using interrupted sutures. Sixteen days later, the second stage was performed, which included pedicle transection and definitive closure of the defect.

Results. The majority of patients (n = 211) achieved excellent outcomes with complete closure of the palatal defect. Early postoperative complications were observed in 3 patients (1.3%): one case of postoperative bleeding that required pedicle transection; one case of flap necrosis; and one case of flap detachment during the second stage. At long-term follow-up, narrow residual defects were observed in 12 patients (9.3%).

Conclusion. The thin mucosal pedicled tongue flap is an effective and reliable technique for the closure of hard palate defects of various shapes, sizes, and locations in children aged 6 to 18 years. This flap modification avoids the drawbacks associated with traditional mucosal-muscle tongue flaps, offering a predictable solution for the surgical repair of palatal defects.

1. Materials of the 21th All-Russian Dental Forum 2024, Moscow, Russia. Russian Journal of Stomatology. 2024;17(3):40 87 (In Russ.). doi:10.17116/rosstomat20241703140

2. Gonchakova SG, Gonchakov GV. Surgical treatment of children with palatal residual defects after the uranoplasty. Kremljovskaya medicina. Klinichesky vestnik. 2016;(3):59-63 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=26932609

3. Chkadua TZ, Romanova EM, Gileva KS, Mokhirev MA, Kudryavcev AV, Arutyunov GR, et al. Rehabilitation of the patient with unilateral cleft lip and palate (case report). Russian Journal of Dentistry. 2018;22(5):249-254 (In Russ.). doi: 10.18821/1728-2802-2018-22-5-249-254

4. Comini LV, Spinelli G, Mannelli G. Algorithm for the treatment of oral and peri-oral defects through local flaps. J Craniomaxillofac Surg. 2018;46(12):2127-2137. doi: 10.1016/j.jcms.2018.09.023

5. Vasishta SM, Krishnan G, Rai YS, Desai A. The versatility of the tongue flap in the closure of palatal fistula. Craniomaxillofac Trauma Reconstr. 2012;5(3):145-60. doi: 10.1055/s-0032-1313352

6. Nawfal F, Hicham B, Achraf B, Rachid B. Repair of large palatal fistula using tongue flap. Afr J Paediatr Surg. 2014;11(1):82-83. doi: 10.4103/0189-6725.129247

7. Jeyaraj PE. A Study on Dorsal Pedicled Tongue Flap Closure of Palatal Fistulae and Oronasal Communications. Ann Maxillofac Surg. 2017;7(2):180-187. doi: 10.4103/ams.ams_94_17

8. Habib AS, Brennan PA. The Deepithelialized Dorsal Tongue Flap for Reconstruction of Anterior Palatal Fistulae: Literature Review and Presentation of Our Experience in Egypt. Cleft Palate Craniofac J. 2016;53(5):589-596. doi: 10.1597/15-017

9. Pramono C. The use of surgical template for palatal fistula repair in cleft palate using tongue flap: 3 case report. Int J Surg Case Rep. 2023;111:108808. doi: 10.1016/j.ijscr.2023.108808

10. Herford AS, Tandon R, Pivetti L, Cicciù M. Closure of large palatal defect using a tongue flap. J Craniofac Surg. 2013;24(3):875-877. doi: 10.1097/SCS.0b013e318285d474