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Rotación de colgajo lingual para el cierre de fistulas palatinas. Revisión bibliográfica

 

Lingual flap rotation for closure of palatinal fistula. Literature review

 


= 1

Víctor Gustavo Balcázar Carras= co

=

https://orcid.org/0009-0000-6152-4084

 

 

Estudiante de la Carrera De Odontología, Universidad Católica De Cuenca, Cuenca, Ecu= ador.

victor.balcazar@est.ucacue.edu.ec

= 2

Santiago José Reinoso Quezada<= /span>

=

https://orcid.org/0000-0002-5597-8909

 

 

Docente de la Carreara de Odontología, Universidad Católica de Cuenca, Cuenca, Ecuador.=

sreinoso@ucacue.edu.ec

 

 

 

 

 

 

Artícu= lo de Investigación Científica y Tecnológica

Enviado: 22/07/2023=

Revisado: 19/08/2023

Aceptado: 01/09/2023

Publicado:29/09/2023   

DOI:      https://doi.org/10.33262/anatomiadigita= l.v6i3.3.2707  =  =           <= /span>                 <= /span>               =

 =

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Cítese= :

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Balcázar Carrasco, V. G., & Reinoso Quezada,= S. J. (2023). Rotación de colgajo lingual para el cierre de fistulas palatin= as. Revisión bibliográfica . Anatomía Digital, 6(3.3), 89-102. https://doi= .org/10.33262/anatomiadigital.v6i3.3.2707

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ANATOMÍA DIGITAL, es u= na Revista Electrónica, Trimestral, que se publicará en soporte electrónico tiene como misión contribuir a la   formación de profesionales competentes con visión humanística y crítica que sean capaces de exp= oner sus resultados investigativos y científicos en la misma medida que se promueva mediante su intervención cambios positivos en la sociedad. = https://anatomiadigital.org  

La revista es editada por la Editorial Ciencia Digital (Editorial de prestigio registrada en la Cámara Ecuatoriana de Libro con No de Afiliación 663) www.celibro.org.= ec

 

 

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Esta revista está protegida bajo una licencia Creative Commons Atribución-NoComercial-CompartirIgual 4.0 International. Copia de la licencia: https://creative= commons.org/licenses/by-nc-sa/4.0/deed.es

 

Palabras claves:=

Fisura del paladar, colgajo de lengua, anomalías maxilomandibulares.

 

Resumen

Intr= oducción. La lengua ha sido utilizada en cirugías reconstructivas orales durante más de un siglo, con el colgajo lingual pediculado introducido por Eiselberg en 1901. Las fístulas palatinas, una malformación congénita que se desarrolla entre la tercera y décima semana= de vida intrauterina, pueden ser causadas por varios factores, incluyendo la dimensión del defecto, la cicatrización fallida, la tensión excesiva de l= os colgajos, la necrosis y los hematomas. Estos defectos producen; dificulta= des en la fono-articulación, halitosis y regurgitación de líquidos desde la cavidad oral hacia la cavidad nasal. Actualmente, la rotación de colgajos linguales es la técnica más recomendada para el cierre hermético de las fístulas palatinas debido a su amplia vascularización y versatilidad. Los colgajos pueden ser de base posterior o anterior, dependiendo del área a corregir. Objetivo. Describir la técnica quirúrgica de rota= ción de colgajos linguales para el cierre de fístulas palatinas. Metodología.  El presente estudio tiene un enfoque descriptivo, p= ara el cual se ha realizado una recopilación de datos que cuentan con informa= ción relevante a cerca de la técnica quirúrgica de rotación de colgajos lingua= les para el cierre de fístulas palatinas realizando una búsqueda en bases digitales como, PubMed, MEDLINE, Scielo y Scopus con los términos “fisura= del paladar”, “colgajo de lengua”, “anomalías maxilomandibulares” Área de estudio general: Odontología. Área de estudio específi= ca: Cirugía Oral y Maxilofacial. Tipo= de estudio:  Revisión Bibliográfica= .

 

 

Keywords:

cleft palate, tongue flap, maxillomandibul= ar anomalies.<= /o:p>

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Abstract

Introduction. The tongue has been used in oral reconstructive surgery for over a century, with the pedicled tongue flap introduced by Eiselberg in 1901. Cleft palate, a congenital malformation that develops between the third and tenth week of intrauterine life, can be caused by several factors, including its size, failed healing, excessive flap tensi= on, necrosis, and hematomas. These defects produce difficulties in phono-articulation, halitosis, and regurgitation of fluids from the oral cavity into the nasal cavity. Currently, lingual flap rotation is the most recommended technique for tight closure of cleft palate due to its wide vascularity and versatility. The flaps can be posterior or anterior based, depending on the area to be corrected. Objective. To describe the surgical technique of lingual fl= ap rotation to close cleft palate. Methodology. The present study has a descriptive approach, for which a compilation of data with relevant information about the surgical technique of tongue flap rotation for the closure of cleft palate has been conducted by searching in digital databases such as PubMed, MEDLINE, SciE= LO, and Scopus with the keywords "cleft palate," "tongue flap," "maxillomandibular anomalies."  

 

 

 

 

Introducción<= /b>

Históricamente la lengua ha sido un tejido ampliamente usado para cirugías reconstructivas= en la cavidad oral por más de cien años, fue en el año 1901 cuando Eiselberg empleó un colgajo lingual pediculado para corregir un defecto intraoral, ya para el año de 1909 Lexer reportaría haber utilizado un colgajo lingual de = base posterior para corregir un defecto localizado en el área retromolar y tonsi= lar. Ya para el año de 1956 Klopp y Schurter describieron y recomendaron a los colgajos linguales para cirugías reconstructivas de paladar blando. No obst= ante, no fue sino hasta 1966 que Guerrero Santos reporta el uso de colgajos lingu= ales con la finalidad de conseguir un cierre hermético de las fístulas palatinas= .1,2

Estas fisuras se consideran una malformación congénita, su origen es embrionario y se desarrolla como tal entre la tercera y décima semana de vi= da intrauterina, los factores hereditarios y ambientales son destacables en el desarrollo de esta malformación. Adicionalmente, la deshisdencia de una palatoplastía primaria puede ser causada por varios factores. Estos incluye= n la dimensión del defecto, la cicatrización fallida, la tensión excesiva de los colgajos, la necrosis y los hematomas. Incluso las técnicas quirúrgicas mal ejecutadas pueden contribuir a este problema. Las fístulas palatinas tienen= síntomas muy marcados y reconocibles fácilmente para el clínico, estos son: defectos= en la fono-articulación, halitosis y regurgitación de líquidos desde la cavidad oral hacia la cavidad nasal. Además, se debe tomar en cuenta que esta malformación afecta también a las estructuras dentarias, puesto que surgen anomalías de forma, tamaño y posición.2,3,4

Hoy en día, existen varias técnicas quirúrgicas para lograr un cierre completam= ente hermético de las fístulas palatinas. Aun así, la rotación de colgajos lingu= ales es la más recomendada y empleada. Esto no se debe a un simple favoritismo, = pues su uso está científicamente sustentado. Se considera que los tejidos lingua= les, que están ampliamente vascularizados, proporcionan un proceso de cicatrizac= ión ideal y rápido. Para el clínico, su uso simplifica la intervención quirúrgi= ca, puesto que la lengua posee una gran versatilidad para transferir tejidos de= ntro de la cavidad oral. Además, un colgajo lingual otorga una amplia facilidad rotacional. 2,4

Para la obtención de colgajos linguales se emplean dos técnicas elementales, tom= ando en cuenta esto la literatura señala que pueden ser de base posterior o de b= ase anterior, su elección dependerá de la estructura en la cual se busque corre= gir un defecto, siendo así los de base posterior para mucosa bucal posterior, á= rea retromolar y paladar blando. En su lugar, los colgajos linguales de base anterior son empleados para corregir aquellos defectos localizados en el paladar duro, sector anterior de la mucosa bucal, piso anterior de la cavid= ad bucal y los labios.4

Metodología

El presente estudio presenta un enfoque descriptivo, para el cual se ha realiz= ado una recopilación de datos que cuentan con información relevante a cerca de = la técnica quirúrgica de rotación de colgajos linguales para el cierre de físt= ulas palatinas.

Estrategia de búsqueda

La búsqueda de los artículos fue realizada en su mayoría en la base de datos d= e la Biblioteca de la Universidad Católica de Cuenca. Dentro de la misma se seleccionó plataformas como PubMed/MEDLINE, SCOPUS y SciELO, además de hacer uso del motor de búsqueda de Google Académico. Para realizar la búsqueda se utilizaron palabras clave como: “fisura del paladar”, “colgajo de lengua”, = “anomalías maxilomandibulares”, “cleft palate”, “tongue flap”, “maxillomandibular anomalies”, términos proporcionados por los descriptrores Mesh (Medical Sub= ject Headings) y Desc (Descriptores en Ciencias de la Salud).  Además de conjugar las palabras claves c= on los Operadores Booleanos, OR y AND, de esta manera se aseguraba obtener datos m= ás precisos y útiles para la investigación.

Criterios de inclusión

Para este artículo se consideraron aquellas publicaciones que incluyan las palab= ras claves (fisura del paladar, colgajo de lengua, y anomalías maxilomandibular= es) y que se encuentren disponibles en los idiomas español e inglés, reportes de casos clínicos, revisiones bibliográficas y publicaciones de libre acceso. = Se consideraron únicamente publicaciones en el rango de tiempo 2013-2023.=

Criterios de exclusión

Fueron descartados aquellos trabajos sin relevancia científica, tales como trabajo= s de titulación, tesis, blogs y portales médicos en línea.

Selección de datos y de cribaje

Después de una selección exhaustiva se obtuvieron un total de 654 textos. Posterior= a eso con la implementación de los filtros y criterios de inclusión y exclusi= ón ya mencionados se seleccionaron 22 documentos.  Por último, con ayuda del cribaje fueron eliminados 6 textos. Como resultado tenemos un total de 16 artículos considerados para este trabajo. Mismos que se distribuyen de la siguiente manera, 13 estudios de caso clínico, 2 estudiosclínicos no aleatorizados y 1 revisión bibliográfica.

Resultados  

Figura 1. Tipos de estudios recopilados

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Figura 2. Diagrama de flujo de selección de artículos

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El diagrama de flujo representa los hallazgos bibliográficos obtenidos a travé= s de una búsqueda digital. Estos resultados fueron seleccionados y organizados sistemáticamente mediante el uso de filtros y un cribado exhaustivo de la información.

Labio y paladar fisurados (LPF):

Es la alteración en la unión de tejidos blandos y duros del labio superior, reborde alveolar. El paladar fisurado puede ser unilateral o bilateral y se= lo puede identificar de dos maneras: una forma en V (fisura primaria) o en for= ma de U (fisura secundaria). Estas malformaciones son congénitas que se desarrollan durante la sexta a decima semana de vida embriofetal. Para la intervención de estas malformaciones se necesita de un equipo multidiscipli= nario conformado por otorrinolaringólogos, odontólogos, cirujanos, psicólogos, foniatras, entre otros. Después de la intervención quirúrgica existen complicaciones en la fistula palatina, sin embargo, existen mejoras en la separación de las cavidades oral y nasal que permiten una adecuada alimenta= ción y habla.1

Fistula palatina:

Es la comunicación anormal entre la cavidad oral y nasal del paladar duro, etiológicamente se relaciona con una complicación en la palatoplastia prima= ria. El 12% y 45% intervenidos con palotoplatias primarias desarrollan esta complicación. La presencia de una fístula posquirúrgica varía como la tensi= ón del colgajo, necrosis, problemas en la cicatrización, técnicas deficientes.= 1, 2

Clasificación de fístulas:

Cohen y Posnick clasificaron las fístulas basándose principalmente en el tamaño q= ue presente el defecto:

1. Hendidura simple: Se considera un defecto mínimo ubicado e= n la línea media, generalmente causado por una pequeña dehiscencia ocurrida sobr= e el paladar duro.3

2. Fístulas pequeñas: Miden menos de 1.5 cm de diámetro, se localizan con frecuencia en la línea media, producidas por una pequeña dehiscencia que ha= ya ocurrido en la unión entre el paladar duro y blando. Aunque también se han reportado debido a la presencia de una necrosis ubicada a nivel de los bord= es de los colgajos del defecto.3

3. Fístulas grandes: Su dimensión es mayor de 1.5 cm de diám= etro y en su mayoría causadas por una necrosis situada a nivel del tercio anteri= or de los colgajos, debido a una probable lesión de la arteria palatina, que comunica con la hendidura alveolar.3

Técnica operatoria

Existen una variedad de colgajos linguales, dentro de los cuales los dorsales son lo más utilizados. Los colgajos de base anterior están indicados principalment= e para tratar defectos del paladar duro. En su lugar, los colgajos de base posteri= or para corregir aquellos defectos situados en el paladar blando. En los dos c= asos se debe evitar levantar las papilas circunvaladas para disminuir el riesgo = de necrosis. Se pueden tomar colgajos de 3mm a 10mm de espesor. Para disminuir= el riesgo de desprendimiento, se recomienda que la base del colgajo vaya ligeramente por atrás del borde posterior del defecto y que tenga un pedícu= lo largo. Para una adecuada perfusión al tejido distal se utiliza un radio lar= go por ancho de 1 cm. En el proceso postoperatorio debe mantenerse una dieta líquida hasta que se libere el pedículo y evitar la apertura bucal. En caso= del pedículo largo, no es necesaria ninguna fijación para la apertura bucal. Pasadas las tres semanas se realiza la prueba de perfusión realizando una sutura en la base del pedículo durante 5 o 10 minutos, se verifica si existe isquemia y se secciona. En caso de isquemia se realiza la prueba después de= 5 días.5,6,7

Esta técnica es muy recomendada por los cirujanos por la simplicidad del protoco= lo quirúrgico y el tiempo que dura la intervención, mismo que no pasa las tres horas.9

A continuación, se describe el procedimiento de la técnica.=

1.&n= bsp;     El paciente es inducido para anestesia general.

2.&n= bsp;     Se realiza una fistulectomía, o se prepara bordes de las fistura para ser receptor del colgajo lingual.

3.&n= bsp;      La lengua debe ser retraída y se realiza = una incisión en sentido horizontal en la superficie ventral de la lengua.1= , 5, 6

4.&n= bsp;      El colgajo es elevado mediante disección a través de toda la dimensión del plano submucoso.1, 5, 6

5.&n= bsp;      Se procede a ejecutar la rotación del col= gajo y se sutura al paladar para cubrir el defecto palatino (fístula).1,6,7=

6.&n= bsp;      El sitio de donde se elevó el colgajo es cerrado mediante suturas.1, 5, 6

Opciones de tratamiento

Cuando existen repercusiones funcionales se realiza una espera de 6 meses después = de la palatoplastía, ya que, la friabilidad de los tejidos dificulta la sutura= . Al escoger la técnica correcta se debe tener en cuenta la localización, tamaño= de la fístula y colaboración del paciente. Las técnicas disponibles son: Colga= jos palatinos, Colgajos Nasales, Colgajos Bucales, Colgajos Cutáneos y aloinjer= tos (matriz dérmica acelular). Indistintamente de la técnica elegida se debe cr= ear un piso nasal en base del epitelio que reviste y rodea la fistula, e import= ante diseñar colgajos 20% más grandes que el defecto con mayor movilidad para disponer de una cobertura completa y sin tensión. 6,7,8, 9

Indicaciones

Inicialmente la rotación de colgajo lingual se había establecido como una alternativa a = la palatoplastías convencionales y otras técnicas quirúrgicas enfocadas a corr= egir los defectos palatinos. Con el paso del tiempo y la aparición de literatura= que sustenta su eficacia y fiabilidad, se sugirió que, en determinados casos y = bajo ciertos parámetros clínicos (ubicación del defecto y tamaño de este) debe s= er el tratamiento de primera elección para el cierre de fístulas palatinas ser= ía esta técnica.1,8,10.

A continuación, se menciona los casos en los que está indicado llevar a cabo la rotación de colgajo lingual para el cierre de fístulas palatinas.

1.&n= bsp;      Cierre de fístulas palatales anteriores.<= sup>5

2.&n= bsp;      Cierre de fístulas palatales grandes (= 805; 5mm).4

3.&n= bsp;      Cierre de fístulas con un diámetro ≥= ; 5 mm que pudieron haberse desarrollado por complicaciones posquirúrgicas o intentos fallidos previos a un cierre previo.1

Contraindicaciones

En ciertas ocasiones resulta inviable llevar a cabo esta técnica. Desde complicaciones sistémicas hasta situaciones que exclusivamente guardan rela= ción con la decisión del paciente o sus representantes, seguidamente se citan las contraindicaciones que el profesional debe tener en consideración cuando ti= ene pensado realizar un colgajo lingual para el cierre de fístulas palatinas.

1.&n= bsp;      Pacientes con condiciones sistémicas seve= ras que los hacen incapaces de tolerar la anestesia general.1,4

2.&n= bsp;      Pacientes con fístulas pequeñas que pueden ser corregidas mediante otras técnicas quirúrgicas.2,3

3.&n= bsp;      Pacientes con superficie lingual inadecua= da o con otros defectos no pueden ser intervenidos con esta técnica.4=

4.&n= bsp;      Pacientes que no están dispuesto a ser tratados bajo anestesia general.2

Implicaciones

Se puede decir en términos generales que, la rotación de colgajo lingual para = el cierre de una fístula palatina es una técnica segura y eficaz, no obstante, durant= e la intervención debido a extensos factores se puede llegar a afectar varias estructuras en la boca y la garganta. Algunas de las estructuras que pueden verse afectadas incluyen:

1.&n= bsp;     Papila incisiva: puede ser lesionada durante la elevación del colgajo lingual.

2.&n= bsp;      Ductos de las glándulas salivales:= Esta estructura se ve comprometida durante la disección del colgajo.1,= 4

3.&n= bsp;       Paladar blando:<= /b> Posterior a la intervención puede haber una alteración temporal en la voz y= la deglución debido a la tensión en el paladar blando misma que es indispensab= le al ejecutar la técnica.6,7

4.&n= bsp;      Músculos del paladar: Al realizar la rotación del colgajo se puede lesionar estos músculos, lo que p= uede desencadenar en problemas temporales como lo son la dificultad en el habla = y la deglución.11,12

Principalmente los músc= ulos que se comprometen en este procedimiento son el geniogloso, músculo de la úvula, tensor del velo del paladar, elevador del velo del paladar, palatofraríngeo y palatogloso.12

5.&n= bsp;      Lengua y sentido del gusto: La rotación del colgajo puede causar edema temporal en la lengua, dando como resultado problemas en el habla mismos que pueden ser temporales o permanen= tes.13,14

Además, durante el procedimiento, algunas maniobras pueden causar daño temporal en el sentido = del gusto en la lengua, pero no suele provocar una pérdida permanente del mismo= .14

Es posible que algunos pacientes experimenten una alteración temporal en el sentido del gusto desp= ués de la cirugía, como una disminución en la intensidad de los sabores o una distorsión en la percepción de estos. Sin embargo, en la mayoría de los cas= os, el sentido del gusto se recupera completamente con el tiempo.

Al ejecutar la técnica = el colgajo lingual es separado de la lengua y se desplazado hacia el paladar p= ara cubrir la fístula. Esto puede provocar una inflamación temporal de la lengu= a y de las papilas gustativas, lo que puede disminuir la sensibilidad al gusto.= Sin embargo, la evidencia clínica respalda que está afectación suele ser tempor= al y se resuelve por sí solo en unas pocas semanas o meses.13,15

6.&n= bsp;      Vasos sanguíneos: Existe el riesgo de daño vascular durante la rotación del colgajo lingual. Al real= izar el desbridamiento, rotación y posterior desplazamiento del colgajo es posib= le que se produzca una lesión de los vasos sanguíneos que suministran sangre al colgajo lingual, principalmente se reportan lesiones en las arterias lingua= l y sublingual.16

Si se produce una lesión vascular durante la rotación de un colgajo lingual para el cierre de una fístula palatina, puede haber una disminución del flujo sanguíneo al colgajo lingua= l y, en casos graves, puede ocurrir la necrosis o muerte del tejido.16,

Si bien es cierto hay muchas estructuras que están involucradas y/o comprometi= das durante el procedimiento de rotación de colgajo lingual para el cierre de fistulas palatinas, no obstante, aunque el cirujano llegase a lesionar moderadamente alguna de las estructuras mencionadas previamente, la evidenc= ia respalda la pronta recuperación de estas. Es de mucha importancia mencionar= que esta técnica requiere ser realizada por un profesional muy bien entrenado y= con amplios conocimientos teóricos.

Conclusiones

La lengua ha sido un tejido ampliamente usado para cirugías reconstructivas en= la cavidad oral por más de cien años.

1.&n= bsp;     Si durante una palatoplastía se forma una fisura palatina resulta útil la rotación de colgajo lingual para el cierre = de esa fisura, además se indica para el cierre de fístulas grandes (≥ 5m= m) y que se ubiquen en la zona anterior del paladar.

2.&n= bsp;     El procedimiento es relativamente sencill= o, se realiza bajo anestesia general y no excede las tres horas.

3.&n= bsp;     Durante el procedimiento muchas estructur= as la cavidad oral están involucradas, por lo tanto, son susceptibles de sufrir alguna lesión, no obstante, muchos de estos daños suelen ser temporales.

Conflicto de intereses

No existe conflicto de intereses ya que el presente estudio es una revisión bibliográfica sin necesidad de la elaboración de un consentimiento informad= o.

Declaración de contribución de los autores

Autor 1: Realizó las funciones de planificación, diseño y redacción de la revisión bibliográfica. Adicionalmente, realizó una revisión crítica y analítica de = los estudios seleccionados, llevando a cabo una evaluación de la calidad metodológica y = la vigencia de la información.

Autor 2: Sus valiosos comentarios, ideas e información han sido muy relevantes, lo cual ayudó a establecer claridad y calidad en el trabajo.=

Referencias Bib= liográficas

= 1.      Partida AI, Lugo RR. Reconstrucc= ión de fístula palatina anterior con colgajo lingual de base anterior. Reporte = de un Caso. Revista Odontológica Mexicana [Internet]. 2016 ;20(1):50–6. Dispon= ible en: https://www.med= igraphic.com/pdfs/odon/uo-2016/uo161i.pdf

= 2.      Velázquez J, Maraz D, Ospino L. Cierre de fístula palatina con colgajo anterior de lengua. Reporte de un ca= so. Revista de la Sociedad Odontológica de la Plata. 2016Mar5; 52:5–8. Disponible en: <= /span>https://pesquis= a.bvsalud.org/portal/resource/pt/lil-795816?lang=3Des

= 3.      Dávalos AD, Ayala RM, Dau EA. Colgajo lingual de pedículo anterior, alternativa quirúrgica para correcció= n de fístula palatina anterior mayor de 2 cm. Revista Colombiana de Cirugía Plás= tica y Reconstructiva. 20221;27(2):41–6. Disponible en: https://www.cip= lastica.com/ojs/index.php/rccp/article/view/179

= 4.      Roldán HG, Vintimilla MD, Maldon= ado CC. Colgajo lingual de base anterior para cierre de fistula palatina anteri= or. Rev. Cir. Traumatol. Buco-Maxilo-Fac. [Internet]. 2019;19(4):24–8. Disponib= le en: https://www.rev= istacirurgiabmf.com/2019/04/Artigos/05ArtClinicoColgajolingualdebaseanterio= r.pdf

= 5.      Reinoso QSJ, Maurat AAK, Heredia-Veloz D. Rotación de colgajo lingual para cierre de fístula palatin= a en pacientes con labio y paladar fisurados realizado en el Hospital Municipal = de la Mujer y el Niño, Cuenca, Ecuador. Rev Odont Mex. 2021; 25 (4): 337-344.Disponible en: https://www.med= igraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=3D108145

= 6.      Wiegering Cecchi Guillermo. Colg= ajo lingual excelente alternativa para el cierre de Fístulas Oronasales: report= e de un caso. Horiz. Med. [Internet]. 16(3): 66-70. Disponible en: http://www.scie= lo.org.pe/scielo.php?script=3Dsci_arttext&pid=3DS1727-558X2016000300010= &lng=3Des

= 7.      San Basilio, M., Bailón, F. L., Berenguer, B., Carrera, E. M., Bayet, B., Taylor, J. A., ... & Mulliken= , J. B. Técnicas y resultados de reparación de fístulas palatinas pospalatoplast= ia: estudio multicéntrico de 234 casos. Cir Pediatr 2020, 33 (5): 137-142. Disponible en: https://www.sec= ipe.org/coldata/upload/revista/2020_33-3ESP_137.pdf

8.&n= bsp;     Nawfal F, Hicham B, Achraf B, Ra= chid B. Repair of large palatal fistula using tongue flap. African Journal of Paediatric Surgery: AJPS 2014 Jan;11(1):82-3. Disponible en: https://www.proquest.com/docview/2071622538/fulltextPDF/E31A9EFE67A8= 48DDPQ/1?accountid=3D61870

= 9.      Medina, R., Giurastante, & Tuninetti, A. Tratamiento de fistula palatina anterior mediante colgajo de lengua. Rev. Méd. Rosario 2017. 83 (7): 119-122, Disponible en: http://www.circ= ulomedicorosario.org/Upload/Directos/Revista/9292f7Faroni.pdf

= 10.  Robalino Torres. D, Sandoval Portilla F, Sandoval Vernimmen F. Colgajo dorsal de lengua de base posterior para cierre de defecto palatino secuela de resección oncológica. Reporte de caso clínico. Odonto Investigación [Internet]. 31 de mayo de 2018 [citado 9= de diciembre de 2022];4(1). Disponible en: https://revista= s.usfq.edu.ec/index.php/odontoinvestigacion/article/view/1121

= 11.  Prakash = A, Singh S, Solanki S, Doshi B, Kolla V, Vyas T, et al. Tongue flap as salvage procedure for recurrent and large palatal fistula after cleft palate repair. African Journal of Paediatric Surgery: AJPS 2018 Apr;15(2):88-92. Disponible en: https://www.pro= quest.com/docview/2255187237/D6604521A3A048ACPQ/1?accountid=3D61870<= /a> (musuclos)

= 12.  Mitchell= B, Diana J, Fatima Q, Joshua M. W, Jordan N. H, S Alex R. Cleft Palate Fistula= : A Review [Internet]. Nih.gov. 2023 [citado el 24 de abril de 2023]. Disponible en: https://www.ncb= i.nlm.nih.gov/pmc/articles/PMC9912053/ (musculos)

= 13.  Barazarte Dionelys, Muñoz Rubén, Golaszewski José, Pulgar Bricelys, Moro Leober, Maldonado Andrea. Use of t= ongue flap as alternative for the closure of palatinal fistulas in patients with sequela of palatoplasty. Rev Esp Cirug Oral y Maxilofac [Internet]. 2020 Jun [citado 2023 Abr 18]; 42(2): 76-82. Disponible en: https://scielo.= isciii.es/pdf/maxi/v42n2/2173-9161-maxi-42-02-00076.pdf (gusto)

= 14.  Rossell-= Perry P. Flap necrosis after palatoplasty in patients with cleft palate. <= span style=3D'font-size:12.0pt;line-height:115%;font-family:"Times New Roman",se= rif; mso-fareast-font-family:"Times New Roman"'>Biomed Res Int [Internet]. 2015 [citado el 18 de abril de 2023]; 2015:516375. Disponible en: https://www.hin= dawi.com/journals/bmri/2015/516375/ (gusto)

15.&= nbsp; Mahajan = R, Chhajlani R, Ghildiyal H. Role of tongue flap in palatal fistula repair: A series of 41 cases. Indian Journal of Plastic Surgery 2014 May;47(2):210-21= 5. Disponible en: https://www.proquest.com/docview/1560163104/2DC57ACC137943ACPQ/1?acc= ountid=3D61870

16.&= nbsp; Moumine = M, Khalfi L, Choumi F. Uses of tongue flaps in oroantral communication. Journa= l of Oral Medicine and Oral Surgery. 2018;24(2):63–6. Disponible en: Uses of tongue flaps in oroantral communication | Journal of Oral Medicine and Oral Surgery (jomos.org)

 

 

 

 

 

 

 

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El artíc= ulo que se publica es de exclusiva responsabilidad de los autores y no necesariamente reflejan el pensamiento de la Revista Anatomía Digital.

 

 

 

 

 

El artículo queda en propiedad de la revista y, por tanto, su publicación parcial y/o total en o= tro medio tiene que ser autorizado por el director de la Revista Anatomía Digital.

 

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ISSN: 2697-3391

Vol. 6 No. 3.3, pp. 89 – 102, s= eptiembre 2023

www= .anatomiadigital.org

 

 

 

 

 

<= span style=3D'mso-spacerun:yes'>                                      Medicina Preventiva                 Página <= span style=3D'mso-no-proof:yes'>89 = | 102<= o:p>

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