Random pattern flapTongue flapAxial pattern flapNasolabial
flapPalatal flapBuccal musculomucosal flap(BMMF)
Tongue flap
Tongue flap
IndicationReconstruction after mass excision Resurfacing of
intraoral defectClosure of fistulaAnatomyLingual arteryDorsal
branch ; posterior based flapDeep lingual branch, sublingual branch
; anterior based flap
Tongue flap
AdvantageEasy approachMinimized defect of donor site Good blood
supplyShort operating timeDisadvantageTemporary disfunction of
tongue for 2~3 weeksCovering of donor site by skin graft
Tongue flap
MethodsPreservation of tongue tipAnterior part of Vallate
papillaeThickness ; 4~7mmWidth ; 2.5~3cmlength ; 5~6cmLimited mouth
opening and mandibular movementSecond operation after 2~3
weeks
Tongue flap (case1)
Large palatal defect involving the entire hard and soft palate
after 3 attempts at closing a recurrent palatal fistula. Only a
small soft tissue band persists as a remnant of the soft
palate.
Tongue flap (case1)
Inferiorly based posterior pharyngeal flap attached to the
posterior margin of the tongue flap. Note the lack of soft tissue
coverage of hard palate posterolaterally.
Tongue flap (case1)
Final result showing closure of the soft tissue gaps in the
posterolateral hard palate using local flaps.
AdvantageGood blood supplyAppropriate thicknessSimilarity of skin
colorLittle hair of flapSmall shrinkage of flapSmall defect of
donor sitePossibility in spite of Radiotheraphy
Nasolabial flap
DisadvatageEsthetic problem ; asymmetric defectLimited size of
flapMethods Based in alinasal siteLength ; 7cmWidth ;
0.5~2.5cm
Nasolabial flap (case1)
(left) Preoperative frontal view of a 70-year-old male with a
melanoma of the right alar region. (center and right) Preoperative
markings showing planned extent of resection and flap design
Nasolabial flap (case1)
(left) Intraoperative photograph showing inset of the flap.(Center,
right) Four-month postoperative views.
Nasolabial flap (case2)
(left) A 54-year-old man with a 2.0 2.0 cm defect following
excision of a basal cell carcinoma.(right) Three-month
postoperative view showing thickening of the flap.
Nasolabial flap (case3)
This defect was reconstructed with the classic nasolabial skin flap
and resulted in less of a donor-site deficit.
Nasolabial flap (case1)
(left) Patient with simultaneous defects of the cheek and nose.
(center) Nonanatomic alar strut graft and superiorly based
nasolabial flap, with the pedicle at its most inferior portion.
(right) Insertion of the flap.
Nasolabial flap (case1)
Full-face view of the patient 6 months after the division and
insertion of the flap.
Palatal flap
Palatal flap
IndicationClosure of oroantral fistulaReconstruction of maxillary
tuberosityLarge defect of extractionLarge palatal
fistulaAnatomyGreater palatine artery
Palatal flap
AdvantageProximity to defect sitesmallest defect of donor siteGood
blood supplyDisadvantageLimited flap sizeLimited
flexibilityExposure of palatal bone
Palatal flap
Methodsconsideration of Greater Palatine arteryno covering of
palatal defectFull recovery of donor site after 3 months
Palatal flap (case1)
(above)Preoperative view of oro-antral communication
(center)Illustration of incision design (below)Intraoperative view
of incision
Palatal flap (case1)
(above) Flap sutured in position.
(below) Late postoperative healing
Buccal flap
Buccal flap
IndicationClosure of oroantral fistulaClosure of palatal
fistulaReconstruction of mouth floorReconstruction of
lipAugmentation of alveolar crestAnatomyAnterior ; facial
arteryPosterior ; buccal artery
Buccal flap
AdvantagePosterior movement of soft palateMinimized imcomplete
maxillary developmentSmalleast post operative constractionTwo layer
overlapping flap ; least fistulaLow velopharyngeal
incompetence(VPI)
Buccal flap
Disadvantageinterruption of maxillary posterior development
Bulkiness of flapimcomplete closure of anterior palate
Buccal flap
Methods Transverse incision between hard palate and soft palate
Patial thickness incisionNasal mucosa ; 1.5cm Z-plastyBilateral
buccal musculomucosal flapWidth ; 1.5cmDirect closure of donor
site
Buccal flap (case1)
Oral side incisions outlined
Buccal flap (case1)
Anterior two-thirds of hard palate closed on nasal side with
turnover mucoperiosteal flaps. Nasal myomucosal flap elevated.
Nasal buccal flap outlined
Commissure-based buccal mucosal flap. This is a random-pedicled
flap based at the oral commissureA commissure-based buccal mucosal
flap can cover an entire vermilion defect
Buccal flap (case3)
(Above) Kaplans buccal mucosal flap for palate reconstruction.
(Below) The buccal mucosal flap is turned in for nasal lining, and
the donor site is closed primarily
Buccal flap (case4)
(Above) right buccal musculomucosal flap-nasal mucosal defect. left
bilobular musculomucosal flap-oral mucosal covering. (Below) A
bilobular musculomucosal flap is rotated to the oral mucosal
defect. Thus, one of the mucosal flaps is turned over for the nasal
surface covering and the other one (bilobate flap) is rotated to
cover the oral mucosal defect.
Palatal flap (Implant)
Diagram. Bucco-palatal view. Distance between arrows, from the most
apical aspect of buccal crest (c) to top of implant body (i), was
measured. Millimetric standard periodontal probe, placed parallel
to long axis of the implant, used to measure distance from the most
apical aspect of buccal crest to top of implant body. In the
present case, a 7 mm dehiscence was recorded.
Palatal flap
Minimal buccal flap, including only interdental papillae and
marginal gingival, exposing bone crest was reflected. Note buccal
bone defect, evident following careful, atraumatic extraction and
elimination of granulation tissue, epithelium and bone inserting
Sharpey's fibers from bony walls. Diagram. Implant in place (thick
arrow). A sharp deep internal beveled incision delineating a
pediculated full thickness palatal flap was performed. An oblique
proximal incision facilitated rotation of pedicle (empty arrow)
which was wider than 5 mm.
Palatal flap
Diagram. Palatal flap rotated (arrows), tucked and sutured under
minimally reflected buccal flap, covering grafted implant
site.
RPF sutured to buccal flap. Portion of RPF covered by buccal flap
was de-epithelialized previous to suturing. Complete primary soft
tissue closure over implant site was achieved.
Palatal flap
Additional sutures secure RPF in the palatal tissues. Surgical
wound in the palate, partially covered by sub-epithelial connective
tissue, heals by secondary intention.. Implant site at time of
second stage implant surgery, primary soft tissue coverage was
maintained.
