title: Dental implants placed into alveolar clefts reconstructed with tongue flaps and bone grafts.
abstract: OBJECTIVE
  The aim of this study was to describe a case series using surgical and prosthodontic modifications of tongue flaps necessary to adapt them for use in the reconstruction of large cleft deformities refractory to customary measures using dental implants and to study their outcomes in patients with complex cleft lip and palate deformities.
  
  
  METHODS
  Five patients were treated with iliac crest bone grafts and covered by anteriorly based tongue flaps divided at either 3 or 4 weeks after surgery. The patients were followed clinically and radiographically for 3-12 years after placement of their dental implants to monitor implant survival and success.
  
  
  RESULTS
  One of the 5 patients suffered a partial tongue flap detachment, graft dehiscence, and recurrence of an oronasal fistula, which was successfully treated by shifting the tongue flap tissue from its new location in the palate. A total of 18 dental implants were placed into bone-grafted tissue covered by the tongue flaps. There was 1 implant failure. There were no cases of periimplantitis or bone loss in the 17 surviving implants.
  
  
  CONCLUSIONS
  Tongue flaps are rarely used clinical entities with a very narrow range of indications. Tongue flaps are useful in the preprosthetic reconstruction of select cases with large residual oronasal fistulae with soft tissue deficits due to scarring from previously failed surgery. Tongue flaps are extremely stressful procedures for patients to endure. Patient selection is of the utmost importance.
authors.affiliation: University of Toronto, Toronto, Canada. george.sandor@utoronto.ca
authors.forename: George K B
authors.initials: GK
authors.lastname: Sándor
authors.forename: Robert P
authors.initials: RP
authors.lastname: Carmichael
authors.forename: Bozidar M B
authors.initials: BM
authors.lastname: Brkovic
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000002:abnormalities / Q000601:surgery; D016025:Bone Transplantation / Q000379:methods; D002971:Cleft Lip / Q000534:rehabilitation; D002972:Cleft Palate / Q000534:rehabilitation*; D003758:Dental Implantation, Endosseous / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000601:surgery*; D016155:Oral Fistula / Q000601:surgery*; D013516:Oral Surgical Procedures, Preprosthetic / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000601:surgery*; D013524:Surgical Flaps; D014059:Tongue / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult