[Surgical correction of oroantral fistulas with integration of mandibular bone]

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.

An observational, descriptive and longitudinal cohort study was carried out in the Maxillofacial Oral Surgery Department in the Specialty Hospital of the 21st 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.

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.

Oroantral communication control is difficult because of mouth fluids, mixed bacterium and a humid environment that promotes development of infection. Therefore, the solution is complicated. 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.

Whatever the etiology of the oroantral communication, the fistulas must be treated immediately 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.