{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:36:45Z","timestamp":1777343805702,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reconstruction of extensive palatal defects in growing patients aims to restore speech intelligibility and swallowing function while avoiding excessive scarring formation that may cause growth disturbances in the palate and midface region. Free flaps transfer healthy, well\u2010vascularized tissue to the defect area, and their combination with pharyngeal flaps allow for restoration of the velopharyngeal function. We examined speech and swallowing after microsurgical palate reconstruction in a series of six pediatric patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Radial forearm free flaps were used in all cases, in combination with a superiorly based pharyngeal flap in five cases. Mean age at surgery was 10.7\u2009years. Etiologies included recurrent oronasal fistula due to failed primary cleft palate repair (<jats:italic>n<\/jats:italic>\u00a0=\u00a04), embryonal rhabdomyosarcoma of the maxilla (<jats:italic>n<\/jats:italic>\u00a0=\u00a01), and inflammatory fibrous hyperplasia (<jats:italic>n<\/jats:italic>\u00a0=\u00a01). Speech evaluations (with the Hirose standard and listener ratings) and swallowing assessments (based on videofluoroscopy swallowing studies and patient\u2010reported swallowing and diet) were performed in average 44\u2009months postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All flaps survived without major postoperative complications. Speech intelligibility was graded as \u201cexcellent\u201d in four patients and \u201cmoderate\u201d in two. Hypernasality and nasal obstruction were each judged as \u201cnone\/minimal\u201d in five cases and \u201cmoderate\u201d in one case. All patients tolerated oral diet without significant nasal regurgitation. In five of six patients, the swallowing assessment showed good motion and velopharyngeal closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Microsurgical reconstruction of extensive palatal defects using radial forearm free flap, with or without a superiorly based pharyngeal flap, is a reliable technique that can deliver substantial improvement of speech and swallowing in pediatric patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30860","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T10:29:39Z","timestamp":1641378579000},"page":"246-253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Speech and swallowing function following microsurgical reconstruction of palatal defects in a series of six pediatric patients"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3503-0106","authenticated-orcid":false,"given":"Abraham","family":"Zavala","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Instituto Nacional de Salud del Ni\u00f1o \u2010 San Borja  Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan V.","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Instituto Nacional de Salud del Ni\u00f1o \u2010 San Borja  Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan F.","family":"Or\u00e9","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Instituto Nacional de Salud del Ni\u00f1o \u2010 San Borja  Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wieslawa","family":"De Pawlikowski","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Instituto Nacional de Salud del Ni\u00f1o \u2010 San Borja  Lima Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1597\/11-065"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(199709)19:6<524::AID-HED10>3.0.CO;2-5"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199211000-00004"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25106"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2880150603"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569(2000)037<0527:TIOSAO>2.0.CO;2"},{"issue":"1","key":"e_1_2_9_8_1","first-page":"51","article-title":"Changes in articulation and resonance after tongue flap closure of palatal fistulas: Case reports","volume":"26","author":"Kummer A. 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