The tongue and forehead flap in the closure of residual oronasal fistulae

Some defects related to untreated palatal or residual clefts represent major deformities. A review of 177 cases, untreated or operated on according to Schwekkendiek's (1958) chronology, was carried out. The advantage of simultaneous operative techniques is discussed, specifically pharyngoplasties, vestibular flap rotation, and osteoplastic closure. When all other surgical possibilities have failed, some flaps have been used to restore mucosal continuity. A multidisciplinary evaluation of each individual case is emphasized.

Cleft palate fistula repair. Improved results by the addition of bone

A retrospective study of cleft palate repairs showed a 22% fistula incidence. Of these 49% were judged to be symptomatic. Of the fistulae, approximately half required treatment. Of the conventional type surgical closures, there was only a 35% success rate. Conventional methods of surgical repair of anterior hard palate fistulae were seen to result in the very poorest permanent closure. As a result of this study, a new protocol was developed which has resulted in marked improvement in the surgical repair of anterior fistulae. We now close these fistulae in early adolescence following completion of orthodontic expansion using gingival and palatal flaps after the addition of free periosteal grafts or cancellous bone grafts.

[Case of dentigerous cyst with a tooth located in the boundary of ethmoidary and sphenoidary sinuses]

This was a case of an 18-year-old Female patient with a swelling in the right side of the face and the oral region. After clinical and radiological examinations, a dentigerous cyst was diagnosed. The cyst developed in the maxillary sinus and the right maxillary wisdom tooth was located in the boundary of ethmoidary and sphenoidary sinuses.

[Oroantral communications. The gold foil method]

The Authors propose the method of the golden leave to close oro-antral communications. The main advantages offered by this technique are the following: 1) marked reduction of the previously observed loss of vertical height of the alveolar bone (7-8% of the original values); 2) the post-operative phase is, most of the time, uneventful.

Nonporous hydroxylapatite in the repair of alveolar clefts in a primate model: clinical and histologic findings

Twelve adult Rhesus monkeys with surgically created alveolar clefts (ACs) underwent repair that used nonporous hydroxylapatite (NPHA) granules on one side and autogenous particulate bone in the contralateral defect. Clinical and radiographic evaluations at 1, 2, 3, 6, and 12 months postoperatively disclosed some displacement of granules initially, but this stabilized by 2 months. Three of 12 sites repaired with NPHA and four of 12 sites repaired with bone dehisced; however, all of these healed by 2 months. No untoward inflammatory or resorptive changes were observed beyond 3 months. The repaired alveolar processes were similar in bulk and contour in sites grafted with NPHA and with bone. Histologically, giant cells were noted at 3 months, but the number decreased at 6 months and remained at that level up to 12 months. The NPHA granules were embedded in mature fibrous connective tissue with osseous ingrowth evident in eight of the 12 defects. It was concluded that NPHA granules are an acceptable implant material for repair of residual alveolar clefts in which erupting teeth and orthodontic movements are not factors.

[Surgical treatment of oroantral fistula. Experience with the use of fibrin glue]

Personal surgical experience in the treatment of oro-antral fistulas is reported. Fifteen patients underwent plastic surgery (palatal strip) and fibrin glue was used to guarantee a better take of the strip.

Tongue flap repair of oro-nasal fistulae in cleft palate patients. A review of 20 patients

At University College Hospital, between 1980 and 1985, sixty patients with cleft lip and palate deformity underwent transpalatal maxillary advancement for the correction of mid-face hypoplasia. One third of these patients subsequently required closure of oro-nasal fistulae and we present the results of these twenty cases where anteriorly based dorsal tongue flaps were used. Seventeen were successful and the causes of three failures are discussed.

A persistent oronasal sinus tract of endodontic origin

Extraoral sinus tracts of endodontic origin may be confused with a wide variety of diseases. Although they may be located in a variety of sites on the face and neck, once diagnosed the treatment is relatively simple and successful. Endodontic therapy is the treatment of choice in these cases; however, periapical surgery may occasionally be required. A case of persistent oronasal sinus is described in which healing occurred only after surgical removal of the involved lesion.

Parotid fistula in children in the tropics

A study of 15 Nigerian children with parotid fistulae was carried out. The causes of the fistulae were found to be infection in nine children (60%), trauma in five (33.3%) and carcinoma in one (6.7%). The commonest infection was tuberculosis, with the primary site in the palatine tonsil and with associated tonsillar gland enlargement. In these cases there was no good response to tympanic neurectomy, surgical repair and anti-tuberculous therapy until palatine tonsillectomy was performed. It is therefore advised that the continued role of the tonsils as a primary site of tuberculous infection in the head and neck must always be sought, even in the management of parotid fistulae in children.

Persistent oral antral fistulas

Oral antral fistulas that have been already subjected to previous attempts at closure have been difficult to treat. Gold foil, bony plugs, and other materials have been used for many years to close these fistulas. Because of all of the various techniques and materials used in this procedure, it has been vexing to evaluate their efficacy. Although the persistent fistula is a rare entity, the surgeons faced with treating this condition must understand the principles of flap closure. In six cases in which multiple attempts at oral antral fistula closure had failed, we used either bilateral or unilateral palatal flaps based on the posterior palatine artery. The patients have been followed up for ten years after surgery and can wear dentures if indicated. There has not been any recurrent fistulization in any of these cases.

Management of an oroantral fistula in a patient with Wilson's disease: case report and review of the literature

After removal of an impacted maxillary third molar, an oroantral fistula developed in a patient with Wilson's disease. Management consisted of antibiotics, decongestants, irrigation, and surgical closure. Complications of treatment did not directly involve the disease but, rather, were related to the therapeutic agent penicillamine. Penicillamine causes interference between the cross links of tropocollagen molecules and cleaves newly formed molecules. Reduction in dosage is recommended when surgery is planned to increase collagen formation and, thus, healing. Such a measure was undertaken in this case. The patient healed uneventfully. A review of Wilson's disease and a case report are presented.

The "tadpole flap"--its role in closure of palatal fistulae

"Tadpole flaps" have been used in a series of 13 cleft palate patients in attempts to close anterior palatal fistulae over a 5-year period. The technique was successful in eight patients whose fistulae remained closed. The failures are discussed in detail.

Secondary closure of oroantral and oronasal fistulas: a modification of existing techniques

Fifty-three patients, 25 with oroantral and 28 with oronasal fistulas, were treated using a modified technique of peripheral de-epithelialization and overlapping flaps. This technique was used with sliding buccal flaps, palatal rotation flaps, palatal island flaps, tongue flaps, and distant tubed pedicle flaps. The advantage of the flap is that it provides more tissue attachment, which promotes healing and resists the tendency of the flap to return to its original position. A high degree of success can be predicted. Only two failures were observed in 53 cases.

Repair of palatal defects with unlined buccal fat pad grafts

The use of unlined buccal fat pad as a pedicled graft to close palatal defects is reported. The advantages of this procedure are described.

Closure of oroantral fistula

Oroantral fistula is an uncommon complication in oral surgery. Although smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always require surgical closures. The literature review revealed various procedures for the closure of oroantral fistulas. These procedures may be subdivided into local flap, distant flap and grafting. Procedures involving local flaps are usually adequate to close minor to moderate size defects. Those procedures utilizing the buccal mucoperiosteal flap as the tissue closure include straight-advancement, rotated, sliding and transversal flap procedures; while those involving the palatal mucoperiosteum are straight advancement, rotational-advancement, hinged and island flap procedures. The combinations of various local flaps to strengthen the tissue closure are also being advocated. The advantages and the limitations of these procedures are discussed. Distant flaps and bone grafts are usually indicated in the closure of larger defects in view of their greater tissue bulks. Tongue flaps have superseded extra-oral flaps from extremities and forehead for aesthetic reasons and also in view of their similar tissue replacement. Various tongue flap procedures are described. At present, various alloplastic materials such as gold, tantalum and polymethylmethacrylate are infrequently reported in the closure of oroantral fistulas. However, in the light of successful reports over the use of biological materials, collagen and fibrin, in the closure of oroantral fistulas, there seems to be another simple alternative technique for treating oroantral fistulas.