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Re: Double-Layered Closure of Chronic Oroantral Fistulas Using a Palatal Rotational Flap and Suturing of the Sinus Membrane Perforation: Is It a Successful Technique?
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LETTER TO THE EDITOR J Oral Maxillofac Surg -:1, 2015
palatal flap in closing variable cOAFs.3,4 We always restrain from using a palatal flap as the first choice procedure because of its longer healing time and considerable patient discomfort resulting from the large denuded area of the palate. In our institute, the palatal flap is reserved for management of recurrent cOAFs in which the pedicled BFP graft has already been used for post-traumatic OAF and for oronasal fistulas owing to their location in the palate.
RE: DOUBLE-LAYERED CLOSURE OF CHRONIC OROANTRAL FISTULAS USING A PALATAL ROTATIONAL FLAP AND SUTURING OF THE SINUS MEMBRANE PERFORATION: IS IT A SUCCESSFUL TECHNIQUE? To the Editor:—We have read with interest the recent article by Sayed et al,1 in which the authors have nicely described the role of the rotational advancement palatal flap in double layer closure of chronic oroantral fistulas (cOAFs). They greatly emphasized the amount of the denuded surface area, number of donor sites, and operating time throughout their report. We would like to draw their attention to the time-tested and clinically established advantages of the highly successful pedicled buccal fat pad (BFP) graft in closing cOAFs, because similar advantages are obtained when it is used. The BFP has been in use for closing variable size OAFs and has been widely documented in published reports. The BFP has various advantages, including local availability, sufficient quantity, a highly vascular nature owing to its blood supply from the maxillary, superficial temporal, and facial arteries, and quick epithelialization.2 However, perforation of the BFP and shrinkage to a certain extent are some of its disadvantages.2 We routinely suture the fibrosed sinus lining after excising the fistula margins and cover the area with a pedicled BFP graft or pedicled BFP graft with a buccal advancement flap (ie, double-layer closure for treating cOAFs). In our experience, slow retrieval, gentle handling, and mattress suturing of the pedicled BFP graft has given excellent results. However, the key for success remains the same—rendering the sinus disease free before attempting any type of OAF closure and patent sinus ostia for drainage in the middle meatus of the nose. Moreover, the advantages (ie, a single donor site, no denuded area, faster epithelialization, rapid recovery, that it is relatively more convenient, even in beginner’s hands, and requires significantly less operating time) outweighs the pedicled BFP graft over the rotational advancement
JITENDER BATRA, MDS GYANANDER ATTRESH, MDS BALRAM GARG, MDS Haryana, India SURYA PORWAL Rajasthan, India
References 1. Sayed AA, Khalifa GA, Hassan SA, Mohamed FI: Double-layered closure of chronic oroantral fistulas using a palatal rotational flap and suturing of the sinus membrane perforation: Is it a successful technique? J Oral Maxillofac Surg 73:812, 2015 2. Anavi Y, Gal G, Silfen R, et al: 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 96: 527, 2003 3. Jain MK, Ramesh C, Sankar K, et al: Pedicled buccal fat pad in the management of oroantral fistula: A clinical study of 15 cases. Int J Oral Maxillofac Surg 41:1025, 2012 4. el-Hakim IE, el-Fakharany AM: The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects. J Laryngol Otol 113:834, 1999
http://dx.doi.org/10.1016/j.joms.2015.04.043
1 COR 5.2.0 DTD YJOMS56814_proof 29 May 2015 7:50 pm CE BD
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LETTER TO THE EDITOR J Oral Maxillofac Surg -:1, 2015
palatal flap in closing variable cOAFs.3,4 We always restrain from using a palatal flap as the first choice procedure because of its longer healing time and considerable patient discomfort resulting from the large denuded area of the palate. In our institute, the palatal flap is reserved for management of recurrent cOAFs in which the pedicled BFP graft has already been used for post-traumatic OAF and for oronasal fistulas owing to their location in the palate.
RE: DOUBLE-LAYERED CLOSURE OF CHRONIC OROANTRAL FISTULAS USING A PALATAL ROTATIONAL FLAP AND SUTURING OF THE SINUS MEMBRANE PERFORATION: IS IT A SUCCESSFUL TECHNIQUE? To the Editor:—We have read with interest the recent article by Sayed et al,1 in which the authors have nicely described the role of the rotational advancement palatal flap in double layer closure of chronic oroantral fistulas (cOAFs). They greatly emphasized the amount of the denuded surface area, number of donor sites, and operating time throughout their report. We would like to draw their attention to the time-tested and clinically established advantages of the highly successful pedicled buccal fat pad (BFP) graft in closing cOAFs, because similar advantages are obtained when it is used. The BFP has been in use for closing variable size OAFs and has been widely documented in published reports. The BFP has various advantages, including local availability, sufficient quantity, a highly vascular nature owing to its blood supply from the maxillary, superficial temporal, and facial arteries, and quick epithelialization.2 However, perforation of the BFP and shrinkage to a certain extent are some of its disadvantages.2 We routinely suture the fibrosed sinus lining after excising the fistula margins and cover the area with a pedicled BFP graft or pedicled BFP graft with a buccal advancement flap (ie, double-layer closure for treating cOAFs). In our experience, slow retrieval, gentle handling, and mattress suturing of the pedicled BFP graft has given excellent results. However, the key for success remains the same—rendering the sinus disease free before attempting any type of OAF closure and patent sinus ostia for drainage in the middle meatus of the nose. Moreover, the advantages (ie, a single donor site, no denuded area, faster epithelialization, rapid recovery, that it is relatively more convenient, even in beginner’s hands, and requires significantly less operating time) outweighs the pedicled BFP graft over the rotational advancement
JITENDER BATRA, MDS GYANANDER ATTRESH, MDS BALRAM GARG, MDS Haryana, India SURYA PORWAL Rajasthan, India
References 1. Sayed AA, Khalifa GA, Hassan SA, Mohamed FI: Double-layered closure of chronic oroantral fistulas using a palatal rotational flap and suturing of the sinus membrane perforation: Is it a successful technique? J Oral Maxillofac Surg 73:812, 2015 2. Anavi Y, Gal G, Silfen R, et al: 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 96: 527, 2003 3. Jain MK, Ramesh C, Sankar K, et al: Pedicled buccal fat pad in the management of oroantral fistula: A clinical study of 15 cases. Int J Oral Maxillofac Surg 41:1025, 2012 4. el-Hakim IE, el-Fakharany AM: The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects. J Laryngol Otol 113:834, 1999
http://dx.doi.org/10.1016/j.joms.2015.04.043
1 COR 5.2.0 DTD YJOMS56814_proof 29 May 2015 7:50 pm CE BD
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