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Y-형 전방 기저 설 피판과 장골 이식을 이용한 양측성 치조열의 이단계 재건술
Two stage reconstruction of bilateral alveolar cleft using Y-shaped anterior based tongue flap and iliac bone graft

대한구순구개열학회지 2000년 3권 1호 p.23 ~ 31

이종호, 김명진, 강진한, 강나라, 이종환, 최원재, 최진영,

소속 상세정보

이종호 ( Lee Jong-Ho ) - 서울대학교 치의학대학원 구강악안면외과학교실
김명진 ( Kim Myung-Jin ) - 서울대학교 치과대학 구강악안면외과학교실
강진한 ( Kang Jin-Han ) - 서울대학교 치과대학 구강악안면외과학교실
강나라 ( Kang Na-Ra ) - 서울대학교 치과대학 구강악안면외과학교실
이종환 ( Lee Jong-Hwan ) - 서울대학교 치과대학 구강악안면외과학교실
최원재 ( Choi Won-Jae ) - 서울대학교 치과대학 구강악안면외과학교실
최진영 ( Choi Jin-Young ) - 서울대학교 치과대학 구강악안면외과학교실

KMID : 0952820000030010023

Abstract

전방 기저 설피판은 비교적 큰 구개 결손을 폐쇄하는데 안전하고 효과적이었으며 후에 장골 이식을 위한 건전한 피복을 제공하였다. 그리고 치조열 결손의 순측면까지 완전히 피복하기 위한 목적으로 양측성 치조열에 적용되도록 재단된 Y-형의 변형은 결과가 믿을 만하였으며 합병증도 무시할 만 하였다.

Objective: When an alveolar cleft is too large to close with adjacent mucobuccal flaps or large secondary fistula following a primary bilateral palatoplasty exists, a one-stage procedure for bone grafting becomes challenging. In such a case, we used the tongue flap to repair the fistula and cleft alveolus in the first stage, and bone grafting to the cleft defect was performed in the second stage several months later. The purpose of this paper is to report our experiences with the use of an anteriorly-based Y-shaped tongue flap to fit the palatal and labial alveolar defects and the ultimate result of the bone graft.

Patients: A series of 14 patients underwent surgery of this type from January 1994 to December 1998.The average age of the patients was 15.8 years old (range: 5 to 28 years old). The mean period of follow-up following the 2nd stage bone raft operation was 45.9 months (range: 9 to 68 months). In nine of the 14 cases, the long-fork type of a Yshaped tongue flap was used for extended coverage of the labial side alveolar defects with the palatal fistula in the remaining cases the short-forked design was used.

Results: All cases demonstrated a good clinical result after the initial repair of cleft alveolus and palatal fistula. There was no fistula recurrence, although Partial necrosis of distal margin in long-forked tongue flap was occurred in one case. Furthermore, the bone graft, which was performed an average of 8 months after the tongue flap repair, was always successful. Occasionally, the transferred tongue tissue was bulging and interfering with the hygienic care of nearby teeth; however, these problems were able to be solved with proper contour-pasty performed afterwards. No donor site complications such as sensory 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 using a Y-shaped tongue flap and iliac bone graft was very successful. It may be indicated for a bilateral cleft alveolus patient where the direct closure of the cleft defect with adjacent tissue or the buccal flap is not easy due to scarred fibrotic mucosa and/or accompanied residual palatal fistula.