Clinical application of the temporoparietal-galeal flap in closure of a chronic oronasal fistula: Review of the anatomy, surgical technique, and report of a case

There are a variety of techniques to close a large chronic oronasal fistula, such as use of a prosthetic obturator, a local flap, or a microvascular flap. We elected to use a TPG flap, which is very versatile and allows for a variety of applications in head and neck surgery. Its thin texture is aesthetically superior to bulkier flaps, and it will conform to the shape of underlying soft tissue. The donor site is inconspicuous and easily hidden by hair growth with minimal morbidity. It is well vascularized and can be maneuvered into a variety of sites about the face and oral region with little difficulty. The use of the TPG flap has been well documented in the literature. Avelar and Psillakis described the use of the "galeal" layers in facial reconstruction, and Horowitz et al described the use of "galeal-pericranial" flaps in a variety of situations in orbital and facial reconstruction. The TPG flap has several advantages: It is reliable with excellent blood supply. It has a good arc of rotation into the oral cavity or face. It has minimal donor site morbidity. It is thin and pliable. The donor site scar is hidden with hair growth. Patient position is supine, and there is no need for interoperative position changes. Potential complications include 1) loss of hair follicles and subsequent scalp alopecia; maintaining a thin layer of fat on the skin flap can minimize this, 2) a surgical scar is seen in men with male pattern baldness, and 3) damage to auriculotemporal nerve, and to the branches of the facial nerve, which can be avoided with careful surgical technique.