Delgado GB, González SÓJ, Villalpando CM, Albores ZD

Language: Spanish
References: 12
Page: 167-172
PDF size: 104.20 Kb.

ABSTRACT

Objective: The goal of this study was to formulate a proposal for an alternative surgical technique for treating ›3 mm oroantral fistulas by integration of mandibular bone, in an attempt to decrease complications due to its invasive nature.
Material y methods: An observational, descriptive and longitudinal cohort study was carried out in the Maxillofacial Oral Surgery Department in the Specialty Hospital of the 21^st Century National Medical Center of the Mexican Institute of Social Security in Mexico City. Sample patients with a diagnosis of oroantral fistula from January 1984 to December 1999 were selected. Surgical correction under general anesthesia was performed with the integration of mandibular osseous graft. Patients were followed postoperatively for 4 years.
Results: Of the 22 patients, 13 were male and 9 female, and all were between 25 and 45 years old (average: 35.5 years). They were treated by application of osseous external mandible graft. In most cases, the graft was covered with a sliding mucoperiosteal flap, two were covered with a racquet-type flap and one only one procedure was Von Lagenbeck type because the nasal floor was involved. None of the patients refused the graft. All patients were followed postoperatively, both clinically and radiologically, for 4 years.
Discussion: Oroantral communication control is difficult because of mouth fluids, mixed bacterium and a humid environment that promotes develop-ment of infection. Therefore, the solution is compli-cated. As a consequence, it is thought that a simple technique such as the use of mandible graft, which offers advantages over others that are performed such as the application of calotte, rib, iliac crest, and perone grafts, but also implies double surgery in distant anatomic areas with particular complications in each one and a longer surgical time.
Conclusions: Whatever the etiology of the oroantral communication, the fistulas must be treated imme-diately after diagnosis. Treatment protocol must be established according to the size and location and presence or absence of infectious process. Successful treatment is achieved by this process.

REFERENCES

1. 1. Anavi Y, Gal G, Silben R, Calderón S. Palatal rotation advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:527-534.

2. 2. Peterson LJ. Principles of oral and maxillofacial surgery. Philadelphia: Lippincott/Mosby; 1992.

3. 3. Baumann A, Ewers R. Application of the buccal fat pad in oral reconstruction. J Oral Maxillofac Surg 2000;8(4):389-392.

4. 4. Van Damme P, Freihoffer HP. Palatal mucoperiosteal expansion as an adjunto palatal fistula repair; case report and review of the literature. Cleft-palate Craniofac J 1996;3(33):88-90.

5. 5. Mewechan JG. Oronasal fistula ocurring after simple dental extraction. Br J Oral Surg 1983;(21):229-230.

6. 6. Hanazawa-Yasuo, Ito-Kohsuke. Closure of oroantral communications using a edicled bucal fat pad graft. J Oral Maxillofac Surg 1995;(53):771-775.

7. 7. Graniszo R, Martin NT. Use if buccal fat pad to repair intraoral defect; review of 30 cases. Br J Oral Maxillofac Surg 1997(35):81-84.

8. 8. Economopolulou P, Laskaris G. Rhinocerebral mucormycosis with severe oral lesions. J Oral Maxillofac Surg 1995;(53):215-217.

9. 9. Kruger GO. Cirugía bucomaxilofacial. México: Médica Panamericana; 2000. p. 411-415.

10. Heggie AA. The use of mandibular buccal cortical grafts in bimaxillary surgery. J Oral Maxillofac Surg 1993;(51):1282-1283.

11. Jensen J, Reiche-Fischel O, Sindet-Pedersen S. Auto-genous mandibular bone grats for malar augmentation. J Oral Maxillofac Surg 1995;(53):88-90.

12. Fonseca RJ. Oral and maxillofacial surgery. Vol. 7. Philadelphia: Mosby; 2000. p. 3-12.