Xia Jiao, Ma Youxiang, Tian Hao, Zhang Ruxiang
a Otorhinolaryngology - Head and Neck Surgery Department , Beijing Friendship Hospital, Capital Medical University , Beijing , PR China.
Acta Otolaryngol. 2019 Aug;139(8):701-706. doi: 10.1080/00016489.2019.1614221. Epub 2019 May 20.
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. This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft. Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed. 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 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. Endonasal repair of OAFs 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.
已经提出了许多技术来闭合口腔上颌窦瘘（OAF），其中大多数涉及使用口腔软组织瓣进行经口修复。若要治疗并存的上颌窦炎，则需要额外采用柯-陆氏手术或鼻内镜鼻窦手术（ESS）。本研究介绍了通过改良鼻内镜内侧上颌骨切除术（MEMM）并使用游离鼻黏膜骨膜软骨膜移植物经鼻闭合OAF的方法。对2013年5月至2018年6月在我科接受闭合手术的16例OAF患者进行了回顾性研究。OAF的主要病因是上颌牙囊肿（56.25%）。OAF大小范围为2×2至10×15毫米。第一磨牙是最常受累的牙齿（62.5%）。所有闭合手术均采用MEMM，使用从鼻中隔或鼻底部获取的鼻黏膜骨膜软骨膜移植物。所有患者均随访至少6个月。93.75%的病例在单次手术后成功闭合。未观察到明显并发症或复发。采用游离鼻黏膜移植物经鼻MEMM修复OAF是可行且有前景的。该方法在术后保留了正常的口腔和鼻腔生理功能。它可单独用于闭合中小型OAF。
