S. P. Dubey MS; C. P. Molumi MMed
Transpalatal approach with pedicled palatal osteo-muco-periosteal flap
Article first published online: 15 DEC 2011
© 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 82, Issue 6, pages 439–442, June 2012
How to Cite
Dubey, S. P. and Molumi, C. P. (2012), Transpalatal approach with pedicled palatal osteo-muco-periosteal flap. ANZ Journal of Surgery, 82: 439–442. doi: 10.1111/j.1445-2197.2011.05954.x
- Issue published online: 3 JUN 2012
- Article first published online: 15 DEC 2011
- Accepted for publication 27 September 2011.
- palatal osteomucoperiosteal flap;
- skull base;
Background: In the conventional technique of transpalatal approach, the palatal mucoperiosteum is incised and widely elevated and hard palate bone is removed in piece meal and discarded. These technique lead to complications, namely, temporary or permanent palatal fistula, palatal scarring leading to palatal disfiguration and velopharyngeal incompetence. In this article we describe a new technique of doing palatotomy to avoid these complications.
Methods: A retrospective review of post-operative complications of 20 patients that underwent transpalatal approach by the conventional technique was performed. To avoid the complications encountered in these cases, a new approach was designed when the palatal mucoperiosteum on the pathological side was elevated partially, greater palatine artery was coagulated and palatal osteotomy was performed from the oral side. On the non-pathological side, hard palate was sectioned from the nasal side, thus preserving the ipsilateral palatal mucoperiosteum. The entire mucoperiosteum with attached hard palate was reflected orally as a single block which was pedicled on the greater palatine artery and palatal mucoperiosteum of the non-pathological side, thereby creating palatal osteo-mucoperiosteal flap. The flap was placed back at the end of the procedure. Eight patients were operated by this new technique.
Results: All 20 patients operated by the conventional transpalatal approach developed post-operative complications. In the eight patients operated by the new technique, no post-operative complications were encountered after 2 years' follow-up.
Conclusions: We found palatal osteo-mucoperiosteal flap an easy and safe way of preserving the hard palate mucoperiosteum and bone with its vasculature resulting in quicker healing and minimal functional impairment.