Chronic oroantral fistula: combined endoscopic and intraoral approach under local anesthesia.
OBJECTIVE
To evaluate the outcome of combined surgical treatment of oroantral communications associated with chronic maxillary sinusitis.


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.
Unit of Maxillofacial Surgery, Department of Neurosciences, University Hospital of Padova, Padova, Italy.
Stefano
S
Fusetti
Enzo
E
Emanuelli
Cristina
C
Ghirotto
Giordana
G
Bettini
Giuseppe
G
Ferronato
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009957:Oroantral Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011862:Radiography, Panoramic / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013515:Surgery, Oral / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome