World Journal of Medical and Surgical Case Reports Volume No 6

Case Report Open Access

Anteriorly Based Tongue Flap for Closure of a Posterior Palatal Defect in a Patient with Exaggerated Gag Reflex

Robert Beech, John Reid, Henry Fung and Leslie Heffez
World Journal of Medical and Surgical Case Reports 2015, 4:10

Abstract

Background

Closure of palatal fistulas requires meticulous attention to detail as well as sound understanding of relevant anatomy. Tongue flaps of various design based on defect location, size and confounding patient factors, have been proven to be effective in closing intraoral defects.

Case Description

A 37 year old Hispanic female presented to our hospital with a palatal pleomorphic adenoma. After initial resection, a split thickness skin graft was performed to the operative site, and prosthesis was fabricated. The patient could not tolerate her obturator secondary to a severe gag reflex, and was left with residual 3x2cm oro-nasal defect.Reconstruction of the defect was planned with the use of an anteriorly based tongue flap due to concerns that the patient’s severe gag reflex would make a traditional posteriorly based flap intolerable.

Practical Implications

The purpose of this article is to describe the options available for closure of an oro-nasal fistula, and describe our use of an anteriorly based dorsal tongue flap to close a large posterior soft palate defect in a patient with a severe gag reflex.The exaggerated reflexes might have otherwise been considered a contraindication.




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