1/6. The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited.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 cm(2). 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.- - - - - - - - - - ranking = 1keywords = island (Clic here for more details about this article) |
2/6. Squamous odontogenic tumor: immunohistochemical identification of keratins.Two cases of squamous odontogenic tumors are described in terms of histopathology and keratin immunohistochemistry. Histopathologically, the lesions were composed of squamous epithelial islands without peripheral columnar cells and well-differentiated stromal tissue. Immunohistochemical detection of keratin proteins was done with the use of polyclonal antikeratin antiserum (TK, detecting 41 to 65 kDa keratins) and monoclonal antibodies (KL1, 55 to 57 kDa; PKK1, 40, 45, and 52.5 kDa). Staining for PKK1-detectable keratin was absent in tumor epithelial cells and that with KL1 and TK immunoreagents was confined to squamous cells, being strong in the keratinized cells. In view of the results, the squamous odontogenic tumor appears to arise from the rests of Malassez in periodontal tissue rather than from oral squamous epithelium.- - - - - - - - - - ranking = 0.11111111111111keywords = island (Clic here for more details about this article) |
3/6. Solitary metastatic melanoma of the soft palate.melanoma of the oral mucosa is frequently situated in the area of the hard palate but extremely rarely in the soft palate. Even metastatic tumors are very rare in this location, and surgery at this stage is seldom indicated. Two patients with solitary metastatic melanoma of the soft palate are described. In both, a subtotal excision of the soft palate was performed, completed by reconstruction with pharyngeal flaps and island flaps from the hard palate. Both patients are alive and free from recurrence 12 years and 4 years after the primary diagnosis of melanoma and 2 years and 18 months after the palatal reconstruction. One patient has normal speech with no nasality; the other patient has very slight hypernasality but no other problems.- - - - - - - - - - ranking = 0.11111111111111keywords = island (Clic here for more details about this article) |
4/6. Acinic cell tumor of the palate.A rare acinic cell carcinoma of the soft palate is reported and its potential for recurrence and metastasis discussed. A wide ablation created a speech-crippling defect that was reconstructed with an island flap from the opposite side and a pharyngeal flap for nasal lining and an island flap from the same side for oral cover. speech is again normal.- - - - - - - - - - ranking = 0.22222222222222keywords = island (Clic here for more details about this article) |
5/6. Follicular lymphoid hyperplasia of the hard palate simulating lymphoma.Follicular lymphoid hyperplasia of the hard palate is a slowly growing, soft, nontender swelling that may grow to involve the entire hard palate. The overlying mucosa is normal. This appearance naturally prompts biopsy, and both clinically and microscopically might be confused with lymphoma. Four case histories are presented with histologic description: normal palatal submucosal structures are replaced with benign reactive lymphoid tissue replete with well-developed germinal centers. Surrounding these centers are dense populations of small, regular, bland lymphocytes. Minor salivary glands, except for some atrophied residue, are notably absent; also absent are the epimyoepithelial islands characteristic of the benign lymphoepithelial lesion (Mikulicz's disease). Etiologic factors remain obscure. One of our patients had two recurrences following local excision; in another patient nodules of benign lymphoid hyperplasia developed in the cheek and upper neck. These four patients are alive and free of any malignant process 4, 7, 9, and 12 years after the onset of their palatal swellings. We urge caution in distinguishing these lesions from palatal lymphoma, and recommend local excision as the treatment of choice.- - - - - - - - - - ranking = 0.11111111111111keywords = island (Clic here for more details about this article) |
6/6. The radial forearm osteocutaneous "sandwich" free flap for reconstruction of the bilateral subtotal maxillectomy defect.Complex resections of the maxilla produce a three-dimensional defect that can be difficult to reconstruct using autogenous tissue without utilizing a free tissue transfer. The osteocutaneous flaps that have been described for reconstruction of this area have been the scapula, iliac crest, and fibula, which are often hampered by their bulkiness and less than ideal intraoral lining. The bilateral subtotal maxillectomy defect is particularly difficult to reconstruct because it requires restoration of the bony framework of the midface as well as the restoration of the palatal and nasal lining. We present a new technique for reconstruction of this type of defect using the osteocutaneous radial forearm free flap. Two patients with bilateral subtotal maxillectomy defects, in whom the entire hard palate and maxillary arch were resected, underwent primary reconstruction. The bone from the osteocutaneous flap was osteotomized and contoured to recreate the maxillary arch. The large skin island was folded around the bone, as in a sandwich, and used to replace the palatal and nasal lining. This sandwiched osteocutaneous flap allowed for secure fitting of a dental prosthesis and the future possibility of osteointegrated implants. Long-term stability of the bone without retrusion was achieved with an excellent functional and aesthetic outcome. The radial forearm osteocutaneous free flap is ideal for the reconstruction of the maxillary infrastructure in that (1) it provides bone and thin, pliable skin in the correct proportions; (2) the described "sandwich" technique restores an excellent functional and aesthetic state; and (3) dental rehabilitation can be further improved by using either a prosthesis or osteointegrated implants.- - - - - - - - - - ranking = 0.11111111111111keywords = island (Clic here for more details about this article) |