New Nasopharyngeal Flap for Posterior Skull-Base Reconstruction: The Upper-Tongue Flap

Introduction Reconstructions of clival resection are still challenging, and additional reconstructive methods may be necessary to achieve full coverage of the skull-base defect in patients with middle- and lower-clivus disease. Objective To describe a new nasopharyngeal flap for the middle and lower clivus. Methods Using nasal endoscopy in a cadaver dissection, we demonstrated a new nasopharygeal flap to cover the lower and middle clival resection. Results We described a new nasopharyngeal flap capable of covering the lower and middle portion of the clivus. Discussion The new nasopharyngeal flap, called the upper-tongue flap, is particularly adequate as an alternative for the reconstruction of middle and lower clivus defects, and it is better used in association with a nasalseptal flap in cases in which the nasalseptal flap alone does not provide enough mucosal coverage. Conclusion The new nasopharyngeal flap can be used in the reconstruction of clival resection.

Closure of Oronasal Fistulae Post Palatoraphy with Tongue Flap in Bilateral Complete Cleft Lip Palate Patient: A Case Report

Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy. Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported. Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful, and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.

Single-Stage Peninsula-Shaped Lateral Tongue Flap Reconstruction for Buccal Defects in Two Patients: Revisiting a Simple and Safe Reconstructive Option

Intraoral defects are increasingly reconstructed using free flaps. However, certain situations may render free flap reconstruction difficult. This study presents two cases with underlying comorbidities that underwent reconstruction of buccal defects involving the retromolar trigone (RMT), using a single-stage peninsula-shaped lateral tongue flap (pLTF). A 58-year-old woman and a 75-year-old man were diagnosed with left buccal squamous cell carcinoma and right buccal adenoid cystic carcinoma, respectively. The buccal defects extending to the RMT area were detected and covered with an ipsilateral posteriorly based pLTF after wide excision of the lesion. All flaps survived without any postoperative complications. Moreover, no tumor recurrences or functional problems were observed during the final follow-up. A single-stage pLTF is believed to represent a good alternative to free flaps in buccal and RMT defects.

BILATERAL CLEFT PALATE REPAIR BY USING TONGUE FLAP FOLLOWED BY ALVEOLAR BONE GRAFTING - A CASE REPORT

A clinical case of bilateral cleft palate repair using previous tongue flap followed by Alveolar Bone Grafting(ABG). After pre-surgical orthodontics a surgical procedure whereby previous tongue Flaps were reflected, nasalbeds were prepared on both sides. A cortico-cancellous bone of 2 cm was harvested from iliac crest and grafted inclefts. Patient is kept on follow up to monitor healing, postoperative results and any post- operative complication.