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The Palatal Island Flap for Reconstruction of Palatal and Retromolar Trigone Defects Revisited
Eric M. Genden, MD;
Bryant B. Lee, MD;
Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 2001;127:837-841.
Background Although a host of local soft tissue flaps have been described for the
reconstruction of postoperative palatal defects, tissue-borne palatal obturators
remain the most common form of rehabilitation of these defects. The palatal
island flap, first applied to the reconstruction of the retromolar trigone
and palatal defects, was first described by Gullane and Arena in 1977. This
single-staged mucoperiosteal flap offers a reliable source of regional vascularized
soft tissue that obviates the need for prosthetic palatal rehabilitation.
Objective To describe a series of 5 cases in which the palatal island flap was
used as a primary palatal or retromolar reconstruction.
Methods We have retrospectively reviewed 5 consecutive cases between March 1998
and August 1999 wherein palatal island flaps were used for the primary reconstruction
of postablative palatal defects. Each case was reviewed for primary pathologic
findings, postoperative wound complications, postoperative speech and swallowing,
and donor site morbidity. Selection of this reconstructive technique was based
on the size and location of the defect and the assessment by the surgeon that
the arc of rotation and amount of residual palatal mucosa were appropriate.
Results Six local palatal island flaps were performed on 5 patients who had
not undergone irradiation (1 patient underwent bilateral flaps). The primary
pathologic findings included T1 N0 squamous cell carcinoma, T4 N0 squamous
cell carcinoma, T2 N0 low-grade mucoepidermoid carcinoma, pigmented neurofibroma,
and T2 N0 low-grade clear cell carcinoma. All of the lesions were located
on the hard or soft palate or the retromolar trigone, and the average defect
size was 7.2 cm2. All 5 patients began an oral diet between postoperative
days 1 and 5 (mean, 2 days), and all patients were discharged home without
postoperative donor site or recipient site complications between days 1 and
6 (mean, 3 days). Donor site reepithelialization was complete by 4 weeks in
all 5 patients.
Conclusions The palatal island flap offers a reliable method of primary reconstruction
for limited lesions of the retromolar trigone and hard and soft palate. The
mucoperiosteal tissue associated with this flap is ideal for partitioning
the oral and nasal cavities and obviates the need for prosthetic palatal obturation.
From the Department of Otolaryngology–Head and Neck Surgery,
Mount Sinai Medical Center, New York, NY.
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Arch Otolaryngol Head Neck Surg. 2001;127(7):889-890.
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