Comparison of Using Palatal and Lingual Flaps to Repair Acquired Medium to Large-Size Hard Palate Defects Based on a Grid Palatal Horizontal Plane Palatal Defect Classification System

Objective: This study aimed to compare the clinical outcomes of repairing acquired palatal defects using palatal island rotation flaps (PRFs) or anteriorly based dorsal tongue flaps (aTFs). Methods: In total, 39 patients (23 males and 16 females) aged 22 to 74 years (median: 48.4 y) were included. According to the grid-based palatal horizontal plane palatal defect classification system, palatal defects were divided into 3 classes (classes I, II, and III); hard palate defects (classes I and II) were further subdivided into 3 subtypes (a, b, and c). Medium and large-sized defects accounted for 56.4% and 43.6% of the cases, respectively. A circumferential incision was made at the margin of the hard palate defect to create marginal buccal and palatal or cheek flaps, which were infolded to form an intranasal lining. Subsequently, either a PRF (59.0%) or an aTF (41.0%) was prepared to form the intraoral lining. The dimensions of the PRFs and aTFs ranged from 1.2×2.2 to 1.4×2.4 cm and from 1.8×2.8 to 2.4×3.2 cm, respectively. Swallowing and speech functions were evaluated at 3 months postoperatively. Results: The dimensions of the aTFs were significantly larger than those of the PRFs (median: 2.2×3.0 cm versus 1.3×2.3 cm, P < 0.05). Postoperative complications, such as hemorrhage or bleeding, dehiscence or fistula formation, and partial flap necrosis, were significantly more common in the PRF group than in the aTF group (43.5% versus 12.5%, P < 0.05). The proportion of patients achieving postoperative swallowing and speech function scores of 3 was significantly higher than the proportion based on preoperative scores ( P < 0.05). Furthermore, patients with medium-sized defects demonstrated significantly higher rates of achieving postoperative swallowing and speech function scores of 3 compared with those with large-sized defects ( P < 0.05). Conclusions: Both PRFs and aTFs are effective for reconstructing acquired medium to large-sized hard palate defects based on the grid palatal horizontal plane palatal defect classification system. However, aTFs offer advantages for larger defects, with a lower incidence of postoperative complications.