Two-stage reconstruction of bilateral alveolar cleft using Y-shaped anterior-based tongue flap and iliac bone graft

Objective: When an alveolar cleft is too large to close with adjacent mucob uccal flaps or large secondary fistula following a primary bilateral palato plasty exists, a one-stage procedure for bone grafting becomes challenging. In such a case, we have used the tongue flap to repair the fistula and cle ft alveolus followed by bone grafting to the cleft defect performed several months later. The purpose of this article is to report on our experiences with the use of an anteriorly based Y-shaped tongue flap to fit the palatal and labial alveolar defects and on the ultimate result of the bone graft. Patients: A series of 14 patients were treated with this approach from Janu ary 1994 to December 1998. The average age of the patients was 15.8 years ( range 5 to 28 years). The mean period of follow-up following the second sta ge bone graft operation was 45.9 months (range 9 to 68 months). In 9 of the 14 patients, the long-fork type of a Y-shaped tongue flap was used for ext ended coverage of the labial-side alveolar defects with the palatal fistula ; in the remaining patients, the short-forked design was used. Results: All patients demonstrated a good clinical result after the initial repair of cleft alveolus and palatal fistula. There was no fistula recurre nce, although partial necrosis of distal margin in long-forked tongue flap occurred in one patient. Furthermore, the bone graft, which was performed a n average of 8 months after the tongue flap repair, was always successful. Occasionally, transferred tongue tissue bulging interfered with the hygieni c care of nearby teeth; however, these problems could be solved with proper contour-plasty performed afterward. No donor site complications such as se nsory disturbance, change in taste, limitations in tongue movement, normal speech impairments, or tongue disfigurement were encountered. Conclusion: This two-stage reconstruction of a bilateral cleft alveolus usi ng a Y-shaped tongue flap and iliac bone graft was very successful. It may be indicated for a bilateral cleft alveolus patient in which the direct clo sure of the cleft defect with adjacent tissue or the buccal flap is not eas y because of scarred fibrotic mucosa and accompanied residual palatal fistu la.