title: Secondary closure of small- to medium-size palatal defects after ablative surgery: reappraisal of reconstructive techniques.
abstract: OBJECTIVE
  Postoncologic reconstruction of the palate represents a major surgical challenge with respect to the thin intraoral and intranasal lining. Current reconstructive methods have ranged from obturative closure of the defect to microsurgical free tissue transfer. The final choice of treatment will be influenced by the size and location of the defect and surgeon experience. The goals of palate repair include optimizing palatal function for speech and eating, and avoiding dehiscence or postoperative fistulas. This study assessed the reliability of locoregional flaps for reconstructing maxillary defects.
  
  
  METHODS
  The present study described the surgical outcome of locoregional reconstruction of the hard and soft palate of 5 patients who had previously undergone tumor ablative surgery. They ranged in age from 19 to 64 years. None had received postoperative radiotherapy. The resultant surgical defects ranged in size from 2.5 to 12 cm(2). One patient experienced velopharyngeal insufficiency.
  
  
  RESULTS
  In all cases, the palate was closed at the first attempt without complications. All flaps survived, and complete closure was obtained in these 4 patients. The patient with the velopharyngeal insufficiency experienced a significant improvement in articulation and swallowing function.
  
  
  CONCLUSIONS
  The results of these 5 cases indicate that secondary locoregional flaps are a suitable alternative for palatal defect management. They have a high success rate and functional outcome. These secondary techniques can be reliably used to reconstruct small- to moderate-size palatal defects and represent a reliable reconstructive option with minimal morbidity.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. Electronic address: Jeroen.Dings@radboudumc.nl.
authors.forename: Jeroen P J
authors.initials: JP
authors.lastname: Dings
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Kariem
authors.initials: K
authors.lastname: Mizbah
authors.affiliation: Department Head, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Stefaan J
authors.initials: SJ
authors.lastname: Bergé
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery and Department of Biomaterials and Periodontology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Meijer
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Mathijs A W
authors.initials: MA
authors.lastname: Merkx
authors.affiliation: OMF Surgeon, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Wilfred A
authors.initials: WA
authors.lastname: Borstlap
mesh_terms: D008949:Adenoma, Pleomorphic / Q000601:surgery; D000328:Adult; D018267:Carcinoma, Acinar Cell / Q000601:surgery; D018277:Carcinoma, Mucoepidermoid / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003679:Deglutition / Q000502:physiology; D004435:Eating / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D010157:Palatal Neoplasms / Q000601:surgery*; D010158:Palatal Obturators; D021362:Palate, Hard / Q000601:surgery*; D010160:Palate, Soft / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013060:Speech / Q000502:physiology; D013524:Surgical Flaps / Q000637:transplantation; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000601:surgery; D055815:Young Adult