Closure of Large Palatal Fistula Using Anteriorly Based Dorsal Tongue Flap in Vietnam: A Case Series

Abstract

Introduction: Vietnam has a high incidence of severe cleft lip and palate, often complicated by palatal fistula (PF) that results in regurgitation, speech impairment, and infection. Anteriorly based dorsal tongue flaps are commonly used to close large PFs, although this technique is novel in Vietnam. This study reports the outcomes of the first implementation of this surgical technique at a leading pediatric institution in Vietnam, which was made possible through successful educational exchanges with international non-governmental organizations. Methods: A retrospective review was performed on the first 3 patients undergoing large PF repairs who were not amenable to standard palatal revision at Vietnam National Children’s Hospital (VNCH) in 2022. Briefly, a 2-stage technique was used. Nasal lining flaps were created and closed. The tongue flap was designed to be slightly wider than the defect, with a minimum thickness of 3 mm and a length of 5 to 6 cm. The anterior portion of the tongue flap was then sutured over the palatal defect. Secondly, the division of the pedicle was performed 20 days later, and the pedicle remnant was returned to the tongue. Results: 3 patients from 9 to 17 years of age were included. Fistula areas were 35 mm × 21 mm, 18 mm × 8 mm, and 21 mm × 7 mm. All were Pittsburgh Type IV-V hard palate fistulas. Complete fistula closure and flap survival were achieved in all patients with no major complications. Patients also had improved hypernasality, nasal emission, resonance, and reduced regurgitation into the nasal cavity. Donor site complications were minimal without significant alterations in taste, swallowing, and tongue mobility postoperatively. Conclusion: We reported the successful pioneering use of anteriorly based dorsal tongue flaps to close large PFs in 3 patients at VNCH. Our success holds promising clinical implications to expand awareness and knowledge of this technique to other facilities in Vietnam as well as to other low-resource settings.