دراسة مقارنة بين استخدام الشرائح الموضعية و الشرائح اللسانية ذات القاعدة الأمامية في إغلاق نواسير قبة الحنك الأمامية متوسطة و كبيرة الاتساع

الملخص EN

Background & Objective: Closing oronasal fistula is one of the many stages the cleft patient may pass through which is troublesome sometimes, because the surrounding tissue of the fistula are scary with lack of blood supply and elasticity this study aim to compare between closing the anterior wide and moderate fistula by using local flap V.S anterior-based tongue flap Methods & Materials: 24 patients have suffering from oronasal fistula from both sex and range from7 to 19 years old were divided into tow groups that we have used local flap in closing the fistula in the first group while we have used the anterior-based tongue flap in the other one None of these patients in both groups has any systemic problems mental statue or bad behavior that may compromise the healing The operations did under the general anesthesia that after applying the mouth retractor of the palatal cleft the fistula became clear and easy to reach so we made several incisions around the fistula to turn over this tissue and suture them together to make the nasal layer in fistula area Then we got the oral nasal by taking flap from the palatal adjacent tissue (local flap) in the first group so we may need surgical appliance to enhance healing in the other group We used anterior-based tongue flap to make the oral layer with fixing and protecting this flap by suturing the tip of the tonguewith the interior side of the upper lip this connection will kept for three weeks till we can separate the flap from the tongue safely After two month of removing the suture we exam the operated area to record the notifications To verify whether there is any recurrent fistula by the mere eye and by asking the patient to open his mouth widely and to blow from his nose with closing the nose by our fingers There were 6 recurrent fistula in the first group ( local flap ) so we have got 50 % as a success rate meanwhile there was only one case of recurrent fistula in the other group ( anterior-based tongue flap ) which detected by the blowing test so we may considered as a partial success so success rate in thisgroup was 91.7 that by using Kay square test we have p=0.025 revealing to a real deference between the two group statically.

Conclusion: The anterior-based tongue flap has better results than the local flap with being more annoying to the patient in the primer healing period So we may advocate depending on our study to use the anterior-based tongue flap in closing the anterior wide and moderate oronasal fistula by using the fixing method of suturing the tip of the tongue with the interior side of the upper lip with leaving the suture with 2 cm length