CLINICAL CASE: PLASTY OF AN EXTENSIVE HARD PALATE DEFECT AFTER URANOPLASTY USING A PEDICAL FLAP FROM THE TONGUE

This paper presents the results of a clinical observation of a 13-year-old patient with a congenital complete cleft lip, alveolar process, soft and hard palate, and an extensive residual defect of the anterior hard palate following uranoplasty. The child underwent a sparing uranoplasty at the age of 2 years and 8 months. Due to a congenital soft tissue deficiency and an unusually wide cleft, the primary surgery failed to completely close the entire cleft. This left a significant defect in the anterior region. At the age of 5, the child underwent a secondary surgery to repair the defect using local tissue. Due to concomitant somatic pathology (acute respiratory viral infection, bronchitis, rhinitis), the wound edges dehisced. An orthodontic intraoral expansion plate was fabricated to temporarily close the defect. Given the lack of local soft tissue around the extensive hard palate defect, we considered the most optimal surgical rehabilitation method to be lingual flap reconstruction using a pedicled tongue flap, as described by G.V. Kruchinsky. The applied pedicled tongue flap technique allowed for complete closure of the extensive anterior hard palate defect, thereby preventing food from entering the nasal cavity, improving the patient's quality of life. Following the staged treatment, a follow-up examination at 3 months demonstrated complete epithelialization and closure of the defect. Therefore, when extensive hard palate defects cannot be closed with local tissues, lingual flap reconstruction is the primary alternative surgical treatment.