Prelaminated calvarial osteofascial flap for palatal reconstruction

Reconstruction of the hard palate defects is among the most challenging problems for plastic surgeons. Prosthetic obturations and local flaps for small defects have been used, whereas numerous regional and free flaps have been described for larger defects. The search for the ideal method offering a natural palatal structure is still ongoing. Five male patients with a mean age of 30.4 years experiencing hard palate defects due to congenital cleft palate or tumor excisions were repaired by prelaminated calvarial osteofascial flap. The mean defect size was 3.14 × 2.48 cm. Both of the surfaces of the calvarial bone elevated with superficial temporal fascia were wrapped with fascia and covered with split-thickness skin graft. The interval between the 2 sessions ranged from 3 to 6 weeks. In the second session, triple layered reconstruction involving the bony layer as well as the oral and nasal mucosa was performed. In 1 case, partial skin loss on the oral surface of the flap was seen in the second session but epithelialized spontaneously. The mean follow-up period was 21.8 months, and no complication such as wound detachment, infection, flap loss, as well as fistula or nasal regurgitation was encountered. A hard palatal reconstruction was performed, offering a natural anatomy in terms of structure and shape. This reliable technique, which is convenient for the three-dimensional reconstruction of the hard palate defects offering a near-normal anatomy owing to its triple layered structure, thickness, and the compatible shape of the calvarial bone to the palate, can be a good alternative against other regional and free flaps.