Cleft Palate Fistula Tongue Flap

Cleft palate fistula tongue flap

One surgical procedure is a tongue flap, in which tissue on the back (top) of the tongue is partially raised and glued to the fistula to seal the opening. It is a two-phase therapy, which is commonly applied to huge or common palatal fistulas.

Indications

A tongue flap is chosen when:

• The fistula is not small particularly at the anterior or mid-palate.
• Repairs have been unsuccessful in the past (recurring fistula).
• There is scarring or insufficiency of local tissue.
• There is impairment in speech because of air leakage in the nose.
• Nasal regurgitation of food or fluids is chronic.

Types of Tongue Flap

• Anterior-based tongue flap - most widely applied in anterior palatal fistula.
• Posterior tongue flap - applied to posterior palate defects.
• Dorsal tongue flap - this is the common method that employs the surface of the tongue.

Tongue flap repair for palatal fistula

Palatal fistula is a hole between the mouth and nose that could be left after cleft palate repair. Tongue flap is one of the surest surgical solutions to defect in the tongue especially when it is recurrent, large, or possesses scarring.

Tongue flap repair Surgery

Stage 1 Tongue Flap Raise and Fistula Seal.

• The size of fistula is indicated on the tongue by the flap.
• This is achieved either by raising a partial-thickness or full-thickness flap with one end attached to preserve blood flow.
• The palatal fistula is closed by rotating and suturing the flap.
• The site of tongue donation is either stitched up or left to heal secondarily.

After Stage 1:

• Tongue is attached to the palate 2-3 weeks.

Stage 2 – Flap Division & Inset

• After incorporating the flap with the palate, it is separated with the tongue.
• The palatal side is removed and fastened.
• Tongue is set at liberty and comes into normal position.

After Tongue Flap Repair Recovery

After Stage 1

• Soft or liquid diet
• Problem talking because the tongue is not that good.
• Do not open the mouth wide or strain the flaps.
• Analgesics to control pain

After Stage 2

• Incremental recovery of tongue movement.
• Normal diet in 1–2 weeks
• Better speech and less nasal regurgitation.

Benefits of Tongue Flap Repair

• Excellent healing: High vascularity.
• Best in big or large fistulas.
• Low recurrence rate
• Excellent prognosis of speech.
• Dependable despite the presence of numerous past surgeries.

Tongue flap complications palatal fistula repair

Even though tongue flap repair has high reliability with success rates of 90-98 percent, complications in this procedure can arise in either the Stage 1 (flap inset) or Stage 2 (flap division).

Flap-Related Complications

Incomplete or Total Flap Necrosis

• Most serious complication
• Brought about by tension, infection or poor blood circulation.
• Prevalent in extremely wide or unvascularized flaps.

Flap Dehiscence

• The breakdown of sutures can be as a result of movement, tension, trauma, or infection.
• May result in residual or recurrent fistula.

Bulky Flap / Overgrowth

• Abnormal tissue that is leading to intraoral discomfort.
• May needs secondary debulking.

Palatal Site Complications

Residual/Recurrent Fistula

• Rare but possible
• Tension, poor integration or infection is usually the cause.
• Smaller and fixable easily often.

Scarring or Contraction

• May affect palatal mobility
• Rare in well-executed flaps

The complications associated with Tongue Donor Site

Bleeding or Hematoma

• Tongue is highly vascular
• During surgery, bleeding should be put under control.

Infection

• Rarely occurs because of blood richness.
• Reacts favorably to antibiotics.

Tongue Sensory Changes

• Provisional numbness or lack of sensation.
• Sensory loss is permanent, infrequent.

Tongue Mobility Speech Pathology (Temporary)

• First 2-3 weeks difficulty in speaking or swallowing.
• Normal mobility is restored following the division of the flaps.

Speech Issues (Temporary)

• Lisping/ distorted articulation following tongue tethering.
• Meanwhile has a typical solution after stage 2.

Feeding and Airway Issues

Difficulty Eating (Temporary)

• Primarily in Stage 1 because of the limitation in the movement of the tongue.
• Soft/ liquid diet recommended.

Airway Obstruction 

• Big flap or excessive swelling can lead to discomfort of the airways.
• Close observation during early postoperative.

Postoperative Care-Related Problems

Trauma to the Flap

• Since the mouth is open wide, crying, tongue moving too much.
• May lead to flap separation.

Bad oral hygiene 

• May cause infection and healing impairment.

Best hospital for cleft palate fistula tongue flap India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

The use of tongue flap repair is one of the most successful and sure-footed procedures to treat large, recurrent, or scarred palatal fistulas when the conventional forms of closure have failed. It has good vascularity, good tissue support, and good success rates, rendering it to be one of the most reliable reconstructive methods of addressing complex defects. The temporary dysfluency in speech, swallowing, and tongue mobility may arise, but the majority of the patients are cured and show high functional outcomes. Tongue flap repair provides lasting closure, increased resonance in the voice and a great deal of increase in the quality of life, when done with careful technique and postoperative attention.

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FAQ

What is the purpose of the use of a tongue flap in palatal fistula repair?

• It is employed when the fistula is massive, recurrent or when the palate contains excessive scarring that the surrounding tissues can close the defect. The tongue flap offers good tissues that are healthy and well-vascularized and heal predictably.

Will the tongue have an everlasting influence?

• No. The mobility, speech and functionality of the tongue return to normal following the division of the tongue flaps. Temporary speech and eating impairment can only be expected.

Does it have an impact on speech?

• Yes--at first--the speech may be incoherent until the flap has been split.
• In the long-run, it enhances speech by avoiding loss of air through the nose.

Will my child experience difficulties in eating or drinking?

• Yes, temporarily. Until the flap is divided a soft or liquid diet should be used. Normal eating then begins after recovery.

Will the scar of the tongue be visible?

• The scar is typically small, and is located on the top of the tongue and is not noticeable.

Is the procedure painful?

• Certain discomfort will be experienced particularly in Stage 1 but pain can be managed with medication.

Which is the earliest age at which a tongue flap may be carried out?

• It may be implemented in children and adults when the patient can safely pass through the period of healing with limited movement of his tongue.

Does the fistula recur following surgery?

• Repeat is not prevalent, yet possible. Care and tension avoidance of the flap is a measure of guaranteed healing.