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Use of a buccinator myomucosal flap and bilateral pedicled buccal fat pad transfer in wide palatal fistula repair: a case report

  • Choi, Jin Mi (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Hojin (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Tae Suk (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2021.07.02
  • Accepted : 2021.08.20
  • Published : 2021.08.20

Abstract

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate-soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI.

Keywords

References

  1. Jeong EC, Jung YH, Shin JY. Use of postoperative palatal obturator after total palatal reconstruction with radial forearm fasciocutaneous free flap. J Craniofac Surg 2015;26:e383-5. https://doi.org/10.1097/SCS.0000000000001856
  2. Agir H, Eren GG, Yasar EK. Acellular dermal matrix use in cleft palate and palatal fistula repair: a potential benefit? J Craniofac Surg 2015;26:1517-22. https://doi.org/10.1097/SCS.0000000000001814
  3. Ashtiani AK, Emami SA, Rasti M. Closure of complicated palatal fistula with facial artery musculomucosal flap. Plast Reconstr Surg 2005;116:381-6. https://doi.org/10.1097/01.PRS.0000142475.63276.87
  4. Helling ER, Dev VR, Garza J, Barone C, Nelluri P, Wang PT. Low fistula rate in palatal clefts closed with the Furlow technique using decellularized dermis. Plast Reconstr Surg 2006;117:2361-5. https://doi.org/10.1097/01.prs.0000218788.44591.f0
  5. Bozola AR, Gasques JA, Carriquiry CE, Cardoso de Oliveira M. The buccinator musculomucosal flap: anatomic study and clinical application. Plast Reconstr Surg 1989;84:250-7. https://doi.org/10.1097/00006534-198908000-00010
  6. Kim SK, Moon JB, Heo J, Kwon YS, Lee KC. The treatment of the large palatal fistula using the tongue flap. J Korean Cleft Palate-Craniofac Assoc 2007;8:49-53.
  7. Ha JH, Jeong Y, Koo YT, Jeon S, Chung J, Kim S. Effect of collagen matrix on postoperative palatal fistula in cleft palate repair. Sci Rep 2020;10:15236. https://doi.org/10.1038/s41598-020-72046-y
  8. Chow TL, Kwan WWY, Fung SC, Ho LI, Au KL. Reconstruction with submental flap for aggressive orofacial cancer: an updated series. Am J Otolaryngol 2018;39:693-7. https://doi.org/10.1016/j.amjoto.2018.07.014
  9. Goh BKL, Chia HL. The use of acellular dermal matrix in combination with pedicled buccal fat pad in wide cleft palate repair: a case report and literature review. Cleft Palate Craniofac J 2019;56:1381-5. https://doi.org/10.1177/1055665619851915
  10. Sommerlad BC. A technique for cleft palate repair. Plast Reconstr Surg 2003;112:1542-8. https://doi.org/10.1097/01.PRS.0000085599.84458.D2
  11. Kim SK, Kim JC, Park SS, Lee KC. One stage correction of the severe secondary cleft lip nasal deformities in foreigners. J Korean Cleft Palate-Craniofac Assoc 2011;12:102-6.
  12. Rahpeyma A, Khajehahmadi S. Buccinator-based myomucosal flaps in intraoral reconstruction: a review and new classification. Natl J Maxillofac Surg 2013;4:25-32. https://doi.org/10.4103/0975-5950.117875
  13. Smith DM, Losee JE. Cleft palate repair. Clin Plast Surg 2014;41:189-210. https://doi.org/10.1016/j.cps.2013.12.005
  14. Rahpeyma A, Khajehahmadi S. Closure of huge palatal fistula in an adult patient with isolated cleft palate: a technical note. Plast Reconstr Surg Glob Open 2015;3:e306. https://doi.org/10.1097/GOX.0000000000000279
  15. Lee YW, Bae YC, Park SM, Nam SB, Seo HJ, Kim GW. Outcomes of a superiorly-based pharyngeal flap for the correction of velopharyngeal dysfunction. Arch Craniofac Surg 2020;21:22-6. https://doi.org/10.7181/acfs.2019.00731
  16. Will LA. Growth and development in patients with untreated clefts. Cleft Palate Craniofac J 2000;37:523-6. https://doi.org/10.1597/1545-1569_2000_037_0523_gadipw_2.0.co_2
  17. Sharma S, Chauhan JS. An infant with a palatal fistula secondary to Candida infection. Arch Craniofac Surg 2020;21:206-9. https://doi.org/10.7181/acfs.2020.00136

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