Ram Hari, Makadia Hardik, Mehta Gagan, Mohammad Shadab, Singh Rakesh Kumar, Singh Nimisha, Singh Geeta
Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India.
J Maxillofac Oral Surg. 2016 Sep;15(3):293-299. doi: 10.1007/s12663-015-0841-y. Epub 2015 Sep 12.
The term oro-antral fistula is understood to mean of fistular canal covered with epithelia which may or may not be filled with granulation tissue or polyposis of the sinus mucous membrane. With the presence of a fistula the sinus is permanently open, which enables the passage of microbial flora of the oral cavity into the maxillary sinus and the occurrence of inflammation with all possible consequences. Every now and then various researchers have proposed innumerable techniques to treat this defect. Starting from simple tissue flaps to autogenous grafts to alloplastic materials, an array of procedures have been evaluated in literature but the most promising technique still needs to be evaluated. Consequently, after reviewing an array of such procedures, our present study focussed on a new technique for the closer of oro-antral fistulas using autogenous auricular cartilage graft supported by buccal advancement flap.
A total of 20 patients of oro-antral fistula were included in the study and after excising the fistular tract a double layer closure was done by placing auricular cartilage over the defect followed by buccal mucoperiosteal flap. The graft was harvested using posterior auricular approach. Assessment of patients was done at the end of 1 week, 3 weeks, 6 weeks, and 3 months.
We found that the autogenous auricular cartilage graft is an effective sealing material in oro-antral fistula closure. We recommend this technique for the defect size ≤10 mm in which future dental implant placement is sought as it allows easy sinus lifting procedure.
口鼻窦瘘这一术语被理解为覆盖有上皮的瘘管,其可能填充或未填充肉芽组织或鼻窦黏膜息肉样变。存在瘘管时,鼻窦会永久性开放,这使得口腔微生物群能够进入上颌窦并引发炎症,进而产生各种可能的后果。不时有不同的研究者提出无数治疗这种缺损的技术。从简单的组织瓣到自体移植物再到异体材料,文献中对一系列手术方法都进行了评估,但最有前景的技术仍有待评估。因此,在回顾了一系列此类手术方法后,我们目前的研究聚焦于一种使用颊侧推进瓣支撑的自体耳软骨移植物来闭合口鼻窦瘘的新技术。
本研究共纳入20例口鼻窦瘘患者,切除瘘管后,通过在缺损处放置耳软骨,然后覆盖颊侧黏骨膜瓣进行双层闭合。采用耳后入路获取移植物。在1周、3周、6周和3个月末对患者进行评估。
我们发现自体耳软骨移植物是闭合口鼻窦瘘的一种有效封闭材料。对于寻求未来植入牙种植体且缺损尺寸≤10毫米的情况,我们推荐这种技术,因为它便于进行鼻窦提升手术。