A case of closure of entire hard palate defect after palatoplasty - Tongue flap repair and its clinical results 6 years postoperatively

SUMMARY Giant secondary fistula in 20-year-old female patient involving the entire hard palate, measuring 32 × 40 mm, could be repaired with a tongue flap which is a simple procedure. The tongue flap used was large and thin without any lining except for turned-up flaps on its margin nor bony support. At 6 years after surgery, slight contracture of the flap was evident, however, the surface of the flap was flat without any scar or wound, nor a fistula. The flap was fibrously hard and a weak touch sensation was evident at the margin of the flap. Narrowing of the tongue was evident extra-orally, however, deformity of the tongue was not remarkable intra-orally. Tongue movement, swallowing and taste were all normal. Complex methods such as distant flaps or free flaps have been reported in such cases of big fistula over 3 cm in diameter, while the tongue flap has not been reported so far. However, in this case, the entire hard palate defect closure has been successfully completed by using tongue flap two-thirds in width of tongue combined with turned-up flap. In the cases of the entire hard palate defects application of the tongue flap may be the procedure of choice before using complex methods.