title: Double-layered closure of chronic oroantral fistulas using a palatal rotational flap and suturing of the sinus membrane perforation: is it a successful technique?
abstract: OBJECTIVE
  Chronic oroantral fistulas (OAFs) are a challenging problem in oral and maxillofacial surgery, and the treatment success rate of OAFs is as low as 67%. Thus, the double-layered closure has been described. The purpose of this study was to evaluate the simplicity and effectiveness of using a palatal rotational flap and suturing of the sinus membrane perforation as a new technique for double-layered closure.
  
  
  METHODS
  A prospective case series study was performed in patients who had chronic OAFs and were treated at Al-Zahraa Hospital from 2010 to 2013. The following demographic and clinical data were collected: age, gender, location of defect, size, etiology, signs and symptoms, postoperative healing, and complications. Under local anesthesia, fistulectomy and sinus irrigation were performed to control sinusitis. Under general anesthesia, the oral side of the fistulous tract was sutured with a purse suture. A palatal flap was reflected and sutured to the buccal tissue.
  
  
  RESULTS
  Twelve patients 19 to 51 years old were enrolled in this study. All patients tolerated the surgical procedures; all surgical wounds healed uneventfully without recurrence.
  
  
  CONCLUSIONS
  Double-layered closure of OAFs is a straightforward, convenient, and successful technique that provides stable, strong, and double-sealed closure of chronic OAFs.
authors.affiliation: Associate Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Sinai University, Sinai, Egypt.
authors.forename: Aliaa Adel
authors.initials: AA
authors.lastname: Sayed
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine (Girls Branch), Al-Azhar University, Cairo, Egypt.
authors.forename: Ghada Amin
authors.initials: GA
authors.lastname: Khalifa
authors.affiliation: Professor and Head, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine (Girls Branch), Al-Azhar University, Cairo, Egypt.
authors.forename: Susan Abd El-Hakim
authors.initials: SA
authors.lastname: Hassan
authors.affiliation: Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine (Girls Branch), Al-Azhar University, Cairo, Egypt. Electronic address: Fatma_Ibrahim36@yahoo.com.
authors.forename: Fatma Ibrahim
authors.initials: FI
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016155:Oral Fistula / Q000601:surgery*; D010159:Palate / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps; D013537:Sutures