Horowitz G, Koren I, Carmel N N, Balaban S, Abu-Ghanem S, Fliss D M, Kleinman S, Reiser V
Refuat Hapeh Vehashinayim (1993). 2015 Jul;32(3):32-7, 68.
There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral BFP regional flap for OAF closure. Total OAF closure, complications and need for revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent rhinorrhea (n = 22, 48.9%), foreign body in sinus (n = 10, 22.2%) nasal congestion (n = 7, 15.5%), halitosis (n = 6, 13.3%) and pain (n = 5, 12.2%). Surgical complications included local pain (n = 2, 4.4%), persistent rhinitis (n = 2, 4.4%) and synechia (n = 1, 2.2%). One patient required revision surgery due, to an unresolved OAF. The OAF of all the other 44 patients (97.8%) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported. Combined, one step, endoscopic Maxillary sinus drainage together with per-oral BFP flap approach is an efficacious surgical approach for safe closure of OAFs that are complicated with secondary chronic maxillary sinusitis.
口腔 - 鼻窦瘘（OAF）闭合有多种手术方法。许多专家仍将继发性鼻窦疾病视为一期闭合的相对禁忌证。描述一种用于治疗导致慢性上颌窦炎的大型OAF的单阶段联合鼻内镜鼻窦手术和经口颊脂垫（BFP）瓣修复方法。回顾了2010年至2013年在我们的三级医疗中心接受治疗的所有患有OAF和继发性鼻 - 鼻窦炎慢性表现患者的记录。排除标准为：OAF <5mm、鼻窦疾病已缓解、继发于恶性肿瘤的OAF、复发性瘘管、有上颌骨放疗病史以及年龄<18岁。每项手术均由鼻科医生和颌面外科医生组成的团队进行。手术方法包括鼻内镜下中鼻道开窗术并建立上颌窦引流，以及经口BFP局部瓣修复OAF。记录OAF完全闭合情况、并发症以及再次手术需求。45例采用鼻内镜鼻窦手术（ESS）联合BFP瓣修复方法进行OAF闭合及鼻窦手术的患者符合纳入标准。其中男性28例，女性17例，平均年龄±标准差为53.5±14.9岁（范围22 - 80岁）。主要症状和体征包括脓性鼻漏（n = 22，48.9%）、鼻窦异物感（n = 10，22.2%）、鼻塞（n = 7，15.5%）、口臭（n = 6，13.3%）和疼痛（n = 5，12.2%）。手术并发症包括局部疼痛（n = 2，4.4%）、持续性鼻炎（n = 2，4.4%）和粘连（n = 1，2.2%）。1例患者因OAF未闭合需要再次手术。其他44例患者（97.8%）在首次手术后OAF闭合，患侧鼻窦完全恢复。该组患者的平均随访时间为7.6±4.3个月（7 - 21个月），未报告不良后遗症或复发情况。联合、一步完成的鼻内镜下上颌窦引流及经口BFP瓣修复方法是一种安全闭合合并继发性慢性上颌窦炎的OAF的有效手术方法。
