There are numerous surgical approaches for oro-
antral-
fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (
BFP) flap approach for large OAF causing chronic
maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary
rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF 5 mm, resolved sino-
nasal disease, OAF secondary to
malignancy, recurrent
fistula, medical history that included
radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral
BFP regional flap for OAF closure. Total OAF closure, complications and need for
revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and
BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent
rhinorrhea (n = 22, 48.9%),
foreign body in sinus (n = 10, 22.2%) nasal congestion (n = 7, 15.5%),
halitosis (n = 6, 13.3%) and
pain (n = 5, 12.2%). Surgical complications included local
pain (n = 2, 4.4%), persistent
rhinitis (n = 2, 4.4%) and synechia (n = 1, 2.2%). One patient required
revision surgery due, to an unresolved OAF. The OAF of all the other 44 patients (97.8%) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported. Combined, one step, endoscopic Maxillary sinus drainage together with per-oral
BFP flap approach is an efficacious surgical approach for safe closure of OAFs that are complicated with secondary chronic
maxillary sinusitis.