Liu Shu-Sen, Heng Wei-Wei, Jiang Ping, Li Chang-Zheng, Hu Xiang-Hai, Li Song
Department of Otorhinolaryngology Nanjing Renpin ENT Hospital Nanjing China.
Department of Otorhinolaryngology, Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China.
World J Otorhinolaryngol Head Neck Surg. 2023 Dec 4;10(4):296-302. doi: 10.1002/wjo2.149. eCollection 2024 Dec.
Oroantral fistula (OAF) is a pathological channel formed between the oral cavity and the maxillary sinus. A large size of OAF (≥5 mm) increases the risk of surgical failure, and an optimal surgical approach should be cautiously selected.
This study aims to characterize the application of nasal endoscopy and buccal fat pad (BFP) flaps to repair large OAFs in patients with odontogenic maxillary sinusitis (OMS).
A total of 32 patients with large OAF combined with OMS after dental extraction who were treated in the Department of Otorhinolaryngology, Nanjing Renpin ENT Hospital from 2018 to 2022, were retrospectively recruited. A thorough preoperative evaluation was performed and all patients were first treated with nasal endoscopy, followed by the repair of OAFs using BFP flaps under general anesthesia. The cure rate and postoperative pain score were used as outcome indicators to evaluate the effectiveness of the procedure.
All patients completed a 12-month follow-up. The results showed that OFAs were cured in 25 (32 in total, 78.1%) patients by the second postoperative week. OFAs were healed in all patients at week 8 postoperatively. OMS was healed in 25 (32 in total, 78.1%) patients at the first postoperative week and all patients were healed by the disappearance of symptoms associated with OMS at week 8 postoperatively. At the second postoperative week, complete relief of pain symptoms was obtained in 18 (32 in total, 56.3%) patients (visual analog scale = 0 score), in 25 (32 in total, 78.1%) patients at the fourth postoperative week, and by the eighth postoperative week, all patients had complete resolution of pain symptoms.
Secondary maxillary sinusitis is not a contraindication to the treatment of large OAFs. Large OAFs can be effectively closed using BFP flaps combined with endoscopic maxillary sinus drainage.
口腔上颌窦瘘（OAF）是口腔与上颌窦之间形成的病理性通道。较大尺寸的OAF（≥5毫米）会增加手术失败的风险，因此应谨慎选择最佳手术方法。
本研究旨在探讨鼻内镜联合颊脂垫（BFP）瓣修复牙源性上颌窦炎（OMS）患者大型OAF的应用效果。
回顾性纳入2018年至2022年在南京仁品耳鼻喉医院耳鼻喉科接受治疗的32例拔牙后合并OMS的大型OAF患者。进行全面的术前评估，所有患者首先接受鼻内镜治疗，然后在全身麻醉下使用BFP瓣修复OAF。以治愈率和术后疼痛评分作为观察指标，评估该手术的有效性。
所有患者均完成了12个月的随访。结果显示，术后第2周，25例（共32例，78.1%）患者的OAF治愈。术后第8周，所有患者的OAF均愈合。术后第1周，25例（共32例，78.1%）患者的OMS愈合，术后第8周，所有患者的OMS相关症状消失，均已愈合。术后第2周，18例（共32例，56.3%）患者的疼痛症状完全缓解（视觉模拟评分=0分），术后第4周，25例（共32例，78.1%）患者疼痛症状完全缓解，术后第8周，所有患者的疼痛症状均完全消失。
继发性上颌窦炎不是大型OAF治疗的禁忌证。BFP瓣联合内镜下上颌窦引流可有效封闭大型OAF。
