Colgajo lingual de pedículo anterior, alternativa quirúrgica para corrección de fistula palatina anterior mayor a 2 cm
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Fecha
2022
Autores
Dávalos Dávalos, Andrés Alfonso
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Ediciones Universidad Simón Bolivar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
La fistula palatina es una comunicación que se presenta entre la cavidad oral y nasal, es una de las secuelas quirúrgicas menos deseables posterior a una reconstrucción de paladar en la que se realiza una palatoplastias. Esta complicación tiene como repercusión importante la afectación en la calidad de vida del paciente debido a que por el defecto en el paladar de los pacientes se va a dar el paso tanto de sólidos y líquidos desde la cavidad oral hacia cavidad nasal, situación con la cual se va a ver una afectación en la parte nutricional de los pacientes, así como en el desarrollo social. El tamaño de la fistula palatina es directamente proporcional con el grado de repercusión en estos pacientes. En el siguiente trabajo se realiza la valoración de los pacientes con diagnóstico de fistula palatina mayor a 2 cm con un abordaje multidisciplinario el cual consiste en odontología, fonoaudiología, otorrinolaringología, pediatría, nutrición, psicología y cirugía plástica en la Clínica Reina Catalina de la ciudad de Barranquilla. Los
pacientes valorados fueron pacientes sometidos a cirugías previas, con defectos
palatinos mayores a 20 mm con abundante tejido cicatrizal y retracción de la mucosa
palatina representando una reconstrucción de mayor complejidad.
El tamaño de la fistula es una variable importante a considerar dado a que ésta va
a repercutir en los pacientes tanto en alimentación, fonación, desarrollo social y
personal con implicaciones en la calidad de vida por lo que es recomendable realizar
la reparación quirúrgica lo antes posible con una técnica quirúrgica la cual sea
segura, estable y definitiva, razón por la que en el trabajo se describe el colgajo
lingual como alternativa quirúrgica con buena evolución posoperatoria a corto,
mediano y largo plazo.
Para el cierre de fistulas palatinas se han descrito varias técnicas quirúrgicas desde
colgajos locales, regionales, microquirúrgicos, hasta uso de obturadores palatinos
con los que se permite el cierre de este defecto, sin embargo, en fistulas de mayor
tamaño, las cuales tienen mayor riesgo de necrosis de colgajos, dehiscencias, o
fallos en el cierre debido a procedimientos previos con tejidos manipulados
previamente los cuales no son de la mejor calidad se recomienda lograr un cierre
completo, estable, y duradero para garantizar la mejoría sobre todo funcional de
estos pacientes.
The palatal fistula is a communication that occurs between the oral and nasal cavities, it is one of the least desirable surgical sequelae after a reconstruction of the palate in which a palatoplasty is performed. This complication has an important repercussion affecting the quality of life of the patient because due to the defect in the palate of the patients, both solids and liquids will pass from the oral cavity to the nasal cavity, a situation with which You will see an affectation in the nutritional part of the patients, as well as in the social development. The size of the palatal fistula is directly proportional to the degree of repercussion in these patients. In the following work, the assessment of patients with a diagnosis of palatal fistula greater than 2 cm is carried out with a multidisciplinary approach which consists of dentistry, speech therapy, otorhinolaryngology, pediatrics, nutrition, psychology and plastic surgery at the Reina Catalina Clinic in the city. from Barranquilla. The patients evaluated were patients who had undergone previous surgeries, with palatal defects greater than 20 mm with abundant scar tissue and retraction of the palatal mucosa, representing a more complex reconstruction. The size of the fistula is an important variable to consider given that it will affect patients in terms of nutrition, phonation, social and personal development with implications for quality of life, so it is advisable to perform surgical repair as soon as possible. with a surgical technique which is safe, stable and definitive, which is why the work describes the lingual flap as a surgical alternative with good postoperative evolution in the short, medium and long term. For the closure of palatal fistulas, several surgical techniques have been described, from local, regional, microsurgical flaps, to the use of palatal obturators with which the closure of this defect is allowed, however, in larger fistulas, which have a higher risk of flap necrosis, wound open, or closure failures due to previous procedures with previously manipulated tissues which are not of the best quality, it is recommended to achieve a complete, stable, and long-lasting closure to guarantee the functional improvement of these patients.
The palatal fistula is a communication that occurs between the oral and nasal cavities, it is one of the least desirable surgical sequelae after a reconstruction of the palate in which a palatoplasty is performed. This complication has an important repercussion affecting the quality of life of the patient because due to the defect in the palate of the patients, both solids and liquids will pass from the oral cavity to the nasal cavity, a situation with which You will see an affectation in the nutritional part of the patients, as well as in the social development. The size of the palatal fistula is directly proportional to the degree of repercussion in these patients. In the following work, the assessment of patients with a diagnosis of palatal fistula greater than 2 cm is carried out with a multidisciplinary approach which consists of dentistry, speech therapy, otorhinolaryngology, pediatrics, nutrition, psychology and plastic surgery at the Reina Catalina Clinic in the city. from Barranquilla. The patients evaluated were patients who had undergone previous surgeries, with palatal defects greater than 20 mm with abundant scar tissue and retraction of the palatal mucosa, representing a more complex reconstruction. The size of the fistula is an important variable to consider given that it will affect patients in terms of nutrition, phonation, social and personal development with implications for quality of life, so it is advisable to perform surgical repair as soon as possible. with a surgical technique which is safe, stable and definitive, which is why the work describes the lingual flap as a surgical alternative with good postoperative evolution in the short, medium and long term. For the closure of palatal fistulas, several surgical techniques have been described, from local, regional, microsurgical flaps, to the use of palatal obturators with which the closure of this defect is allowed, however, in larger fistulas, which have a higher risk of flap necrosis, wound open, or closure failures due to previous procedures with previously manipulated tissues which are not of the best quality, it is recommended to achieve a complete, stable, and long-lasting closure to guarantee the functional improvement of these patients.
Descripción
Palabras clave
Colgajo lengua, Fistula palatina, Paladar hendido, Tongue flap, Palatal fistula, Cleft palate