PP004: The need for temporary palatal obturator for total palatal reconstruction with radial forearm free flap

Abstract

Confident reconstruction of palatal defect by radial forearm fasciocutaneous free flap. A 67 year male patient who had total palate defect including hard palate after the ablative surgery of adenoid cystic carcinoma originating from soft palate were immediately reconstructed using radial forearm fasciocutaneous free flap to restore nasal and oral separation. Vascular anastomoses were done with facial vessels in neck and the donor site was closed with split thickness skin graft. All suture wounds in the oral and nasal side had healed primarily without complication till the postoperative 14th day. But the disruption of wounds and downward prolapsed of flap was noticed in the oral cavity during the follow-up session and it required revisional operation. During the revisional operation, a prefabricated temporal palatal obturator for the protection of the repair wounds and the anti-gravitational support was applied beneath the flap. After applying palatal obturator, no more disruption was reported in the additional follow-ups. The patient was then able to swallow soluble foods in the 3 weeks postoperatively and prepare the further radiation therapy. The temporary palatal obturator was safely removed 6 weeks after revisional operation. Radial forearm fasciocutaneous free flap is versatile for soft tissue reconstruction of palate which provides a satisfactory separation between oral and nasal cavity. But it can be prolapsed down due to gravity and its bulk and this makes disruption of the wound during early postoperative period. The temporary palatal obturator was a good answer to sustain the flap in place until secure implantation.