Repair of oroantral fistula via modified endoscopic medial maxillectomy with free nasal mucoperichondrial-osteal graft

Abstract

Background: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue flaps. An additional Caldwell-Luc approach or endoscopic sinus surgery (ESS) is required to address coexisting maxillary sinusitis.

Objectives: This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft.

Materials and methods: Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed.

Results: The main cause of OAF was maxillary dental cysts (56.25%). The OAF size ranged from 2 × 2 to 10 × 15 mm. The first molar (62.5%) was the most frequently involved tooth. All closures were made via MEMM, using nasal mucoperichondrial-osteal grafts harvested from the septum or nasal base. All patients were followed up for at least six months. Successful closure after a single procedure was achieved in 93.75% of cases. No obvious complications or recurrences were observed.

Conclusions: Endonasal repair of OAFs via MEMM with free nasal mucosal grafts is feasible and promising. The approach preserves the normal oral and nasal physiology after surgery. It could be used alone for the closure of small to medium-sized OAFs.

Chinese abstract

背景：已提出许多技术用于关闭口瘘（OAF）, 其中大多数涉及用口软组织瓣作经口修复。为了治疗共存上颌鼻窦炎, 需要额外的考德威尔-卢克（Caldwell-Luc）入路或内窥镜鼻窦手术（ESS）。

目的：本研究采用改良的鼻内窥镜内上颌切除术（MEMM）和游离的鼻粘膜软骨膜骨膜移植术, 对OAF进行鼻内闭合。

材料与方法：回顾性分析我科2013年5月至2018年6月收治的16例OAF患者。

结果：上颌牙囊肿（56.25%）是导致OAF的主要原因。OAF尺寸范围为2 × 2至10 × 15 mm。第一磨牙（62.5%）是最常受累的牙齿。所有的闭合都是通过MEMM, 使用鼻中隔或鼻底的鼻粘膜软骨膜骨膜移植。所有患者至少随访6个月。93.75%的病例在一次手术后成功闭合。无明显并发症或复发。

结论：运用MEMM的鼻黏膜游离移植来进行OAF鼻内修复是可行的, 具有广阔的应用前景。该方法能保持术后正常的口腔和鼻腔生理。它可以单独用于关闭中小型OAF。

Keywords:

• Oroantral fistula
• endonasal
• surgical closure technique
• modified endoscopic medial maxillectomy
• graft
• sinus surgery

Disclosure statement

No potential conflict of interest was reported by the authors.