Tongue Flap for Closure of an Oronasal Communication Induced by Cocaine Use

Oro-nasal fistulas may result from congenital defects, trauma, infections, neoplasms, or chronic cocaine use, affecting speech, swallowing, and quality of life. The tongue flap stands out for its rich vascularization and low donor-site morbidity. A 36-year-old female presented with nasal speech and liquid regurgitation through the nose. She had a history of chronic cocaine use for 7 years, discontinued 2 years prior. Clinical and radiographic examination revealed a 2.0 cm oro-nasal fistula in the hard palate. Reconstruction was performed under general anesthesia using an anteriorly based pedicled tongue flap, secured to the recipient bed with 3-0 Vicryl sutures. Maxillomandibular fixation was maintained for 21 days, and the flap was divided after 3 weeks. The anteriorly based tongue flap proved to be a reliable and effective technique for closing large cocaine-induced oro-nasal fistulas, offering excellent functional and aesthetic outcomes.