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Boot M, Winters R. Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis. Curr Opin Otolaryngol Head Neck Surg 2024; 32:269-277. [PMID: 38393699 DOI: 10.1097/moo.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE OF REVIEW Massive palatal defects resulting from palatoplasty failures arising from cleft palate repair complications present ongoing challenges in clinical practice. The purpose of this review is to provide up-to-date insights into aetiology, risk factors, surgical techniques, and adjunctive therapies, aiming to enhance the understanding of such complex cases, and optimize patient outcomes. RECENT FINDINGS Primary palatoplasty has fistula recurrence rates ranging from 2.4% to 55%. Factors such as cleft width, surgical repair method, and patient characteristics, influence the likelihood of failure. Classifications such as the Pakistan Comprehensive Classification and Richardson's criteria aid in assessing defects. Surgical options range from local flaps and revision palatoplasty to regional flaps (e.g., buccinator myomucosal, facial artery-based flaps, tongue flaps, nasal septal flaps) to free microvascular flaps. Alternative approaches include obturator prostheses, and acellular dermal matrix has been used as an adjuvant to multiple repair techniques. Hyperbaric oxygen therapy has emerged as an adjunctive therapy to enhance tissue healing. SUMMARY This comprehensive review underscores the intricate challenges associated with massive palatal defects resulting from palatoplasty failures. The diverse range of surgical and nonsurgical options emphasizes the importance of patient-centric, individualized approaches. Practitioners, armed with evidence-based insights, can navigate these complexities, offering tailored interventions for improved patient outcomes.
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Affiliation(s)
- Madison Boot
- John Hunter Hospital Department of Otolaryngology - Head & Neck Surgery, New Lambton Heights, NSW, Australia
| | - Ryan Winters
- John Hunter Hospital Department of Otolaryngology - Head & Neck Surgery, New Lambton Heights, NSW, Australia
- Tulane University Department of Otolaryngology - Head & Neck Surgery
- Tulane University Division of Plastic & Reconstructive Surgery, New Orleans, Louisiana, USA
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Adekunle AA, James O, Olanbiwonnu AO, Adeyemo WL. A Review of the Use of Buccal Fat Pad in Cleft Palate Repair. Cleft Palate Craniofac J 2024; 61:1116-1124. [PMID: 36760091 DOI: 10.1177/10556656231155768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair. METHODS This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate. RESULTS A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n = 16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects. CONCLUSION The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia.
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Affiliation(s)
- Adegbayi Adeola Adekunle
- Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Wasiu Lanre Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Deot N, Tatum SA. Revision Palate Surgery. Facial Plast Surg Clin North Am 2024; 32:63-68. [PMID: 37981417 DOI: 10.1016/j.fsc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Oronasal fistulae and velopharyngeal insufficiency are common and interdependent complications after cleft palate surgery. Bone grafting can complement cleft habilitation. Early identification and intervention are vital for optimal outcomes. Collaboration with experienced healthcare professionals is crucial to develop a comprehensive treatment plan which considers speech therapy, prosthetic devices, and surgery. This article aims to review the current literature on the management of VPI and oronasal fistulae following cleft palate surgery and additionally highlight the role of alveolar bone grafting to improve outcomes for these patients.
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Affiliation(s)
- Neal Deot
- Department of Otolaryngology, Upstate Medical University, Syracuse, NY, USA.
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Copelli C, Manfuso A, Di Maio P, Garzino-Demo P, Iocca O. Myomucosal island flap in the reconstruction of oral cavity defects: Description of the surgical technique. Head Neck 2023; 45:745-751. [PMID: 36470675 PMCID: PMC10107332 DOI: 10.1002/hed.27251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/06/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Multiple options are available for the reconstruction of the defects of the oral cavity. Among these, the facial artery myomucosal island flap (FAMMIF) is a pedicled flap composed by cheek mucosa, submucosa, and part of the buccinator muscle. The FAMMIF is ideal for the reconstruction of small-to-moderate defects of the oral cavity and the oropharynx. This is due to low operating time, low morbidity, and good functional and aesthetic results. A step-by-step description of the flap harvesting is presented, with particular attention to flap design, identification of the vessels, harvesting of the myomucosal island, tunnel preparation for its passage in the neck and back to the oral cavity, and closure of the cheek donor site with the buccal fat pad.
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Affiliation(s)
- Chiara Copelli
- Division of Maxillofacial Surgery, Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Alfonso Manfuso
- Operative Unit of Maxillofacial Surgery, Otolaryngology and Dentistry, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Fg), Italy
| | - Pasquale Di Maio
- Department of Otolaryngology - Head Neck Surgery, Hospital of Magenta, Milano, Italy
| | - Paolo Garzino-Demo
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Torino, Italy
| | - Oreste Iocca
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Torino, Italy
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Frohwitter G, Kesting MR, Rau A, Weber M, Baran C, Nobis CP, Buentemeyer TO, Preidl R, Lutz R. Pedicled buccal flaps as a backup procedure for intraoral reconstruction. Oral Maxillofac Surg 2023; 27:117-124. [PMID: 35072841 PMCID: PMC9938028 DOI: 10.1007/s10006-022-01040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intraoral soft tissue deficiency and impaired wound beds are common problems after cleft and tumour surgery or after dental trauma. Frequently, limited defects are overtreated with extensive microvascular reconstruction procedures, but pedicled flaps remain useful, as they are simple to harvest, and they provide a reliable outcome. The buccal flap, first described in the 1970s, has been used for palatine lengthening in cleft patients over decades. In the following, we present an expanded indication in cases of palatal fistula, complex vestibulum, exposed bone in orthognathic surgery, and osteoradionecrosis. METHODS We conducted a retrospective chart review and report on all buccal flaps harvested in our department within the last 3 years with a follow-up period of at least half a year after flap surgery. Patients of all age groups and treatment indications in which a buccal flap was used were implicated in the evaluation. RESULTS Sixteen buccal flaps were performed in 10 patients. The median age at the time of surgery was 42 years, reaching from 12 up to 66 years. Fourteen buccal flaps were used for upper jaw or palatal coverage; two buccal flaps were used in the mandible. In terms of complications (four flaps; 25%), there were two partial flap failures, one wound dehiscence and one wound dehiscence. There were no failures of the remaining mucosal flap islands after pedicle dissection. CONCLUSION The buccal flap is a reliable and straightforward approach to challenging intraoral wound beds with soft tissue deficiency. We thoroughly discuss the additional indications for buccal flap surgery, describe the harvest technique, and provide strategies to prevent intra- and postoperative complications.
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Affiliation(s)
- Gesche Frohwitter
- Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054, Erlangen, Germany.
| | - Marco R. Kesting
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Andrea Rau
- grid.412469.c0000 0000 9116 8976Department for Oral and Maxillofacial Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Manuel Weber
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Christoph Baran
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Christopher-Philipp Nobis
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Tjark-Ole Buentemeyer
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Raimund Preidl
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
| | - Rainer Lutz
- grid.411668.c0000 0000 9935 6525Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany
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Cao L, Su H, Si M, Xu J, Chang X, Lv J, Zhai Y. Tissue Engineering in Stomatology: A Review of Potential Approaches for Oral Disease Treatments. Front Bioeng Biotechnol 2021; 9:662418. [PMID: 34820359 PMCID: PMC8606749 DOI: 10.3389/fbioe.2021.662418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/01/2021] [Indexed: 01/09/2023] Open
Abstract
Tissue engineering is an emerging discipline that combines engineering and life sciences. It can construct functional biological structures in vivo or in vitro to replace native tissues or organs and minimize serious shortages of donor organs during tissue and organ reconstruction or transplantation. Organ transplantation has achieved success by using the tissue-engineered heart, liver, kidney, and other artificial organs, and the emergence of tissue-engineered bone also provides a new approach for the healing of human bone defects. In recent years, tissue engineering technology has gradually become an important technical method for dentistry research, and its application in stomatology-related research has also obtained impressive achievements. The purpose of this review is to summarize the research advances of tissue engineering and its application in stomatology. These aspects include tooth, periodontal, dental implant, cleft palate, oral and maxillofacial skin or mucosa, and oral and maxillofacial bone tissue engineering. In addition, this article also summarizes the commonly used cells, scaffolds, and growth factors in stomatology and discusses the limitations of tissue engineering in stomatology from the perspective of cells, scaffolds, and clinical applications.
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Affiliation(s)
- Lilan Cao
- School of Stomatology, Henan University, Kaifeng, China
| | - Huiying Su
- School of Stomatology, Henan University, Kaifeng, China
| | - Mengying Si
- School of Stomatology, Henan University, Kaifeng, China
| | - Jing Xu
- School of Stomatology, Henan University, Kaifeng, China
| | - Xin Chang
- School of Stomatology, Henan University, Kaifeng, China
| | - Jiajia Lv
- School of Stomatology, Henan University, Kaifeng, China.,Henan International Joint Laboratory for Nuclear Protein Regulation, Kaifeng, China
| | - Yuankun Zhai
- School of Stomatology, Henan University, Kaifeng, China.,Henan International Joint Laboratory for Nuclear Protein Regulation, Kaifeng, China
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