Chronic oroantral fistula: combined endoscopic and intraoral approach under local anesthesia

Am J Otolaryngol. 2013 Jul-Aug;34(4):323-6. doi: 10.1016/j.amjoto.2012.12.015. Epub 2013 Jan 26.

Abstract

Objective: To evaluate the outcome of combined surgical treatment of oroantral communications associated with chronic maxillary sinusitis.

Patients and methods: 8 consecutive patients affected by complicated oroantral fistula were included in the study. The protocol consisted of: clinical, endoscopic and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy 2 weeks before surgery; one-stage surgical procedure under local anaesthesia consisting in uncinectomy with enlargement of the osteomeatal complex through endoscopic nasal approach associated with the closure of the oroantral communication by means of a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy. Follow-up consisted of weekly clinical evaluation during the first month, and nasal endoscopy at 3, 8 and 24 weeks after surgery.

Results: After surgical treatment, all patients were symptom-free and had no endoscopic and radiological evidences of maxillary sinusitis at the 6-month follow-up. No recurrent oroantral fistulas were found.

Conclusions: The current prospective study showed that a one-stage, combined endoscopic and intraoral approach under local anaesthesia represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated oroantral communications. Moreover, it represents an easily applicable approach also in outpatient clinics with minor patient discomfort.

MeSH terms

  • Adult
  • Aged
  • Anesthesia, Local
  • Chronic Disease
  • Combined Modality Therapy
  • Endoscopy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Maxillary Sinusitis / complications
  • Maxillary Sinusitis / diagnostic imaging
  • Maxillary Sinusitis / surgery*
  • Middle Aged
  • Oroantral Fistula / complications
  • Oroantral Fistula / diagnostic imaging
  • Oroantral Fistula / surgery*
  • Plastic Surgery Procedures / methods
  • Prospective Studies
  • Radiography, Panoramic / methods
  • Risk Assessment
  • Sampling Studies
  • Severity of Illness Index
  • Surgery, Oral / methods*
  • Surgical Flaps / blood supply*
  • Tomography, X-Ray Computed
  • Treatment Outcome