Repair of Oroantral Communications by Use of a Combined Surgical Approach: Functional Endoscopic Surgery and Buccal Advancement Flap/Buccal Fat Pad Graft

The purpose of this study was to evaluate the efficacy of a combined surgical approach for repair of oroantral communications.

This retrospective study evaluated the effectiveness of the combined surgical approach of functional endoscopic sinus surgery and buccal advancement flap or buccal fat pad grafting. Forty-three patients with chronic sinusitis from 2007 to 2013 were evaluated after combined functional endoscopic sinus surgery and closure of oroantral communication with a buccal fat pad graft or buccal advancement flap for persistent oroantral communication. Treatment included preoperative computed tomography, antibiotic therapy, exploration and removal of sinus pathologic tissues, rotation of a pedicled fat pad graft into the oral opening, repair and closure of oral mucosa, exploration of involved sinuses with excision of sinus and nasal tissues necessary for establishment of osteomeatal drainage, and follow-up to evaluate the success or failure of treatment.

The results were overwhelmingly positive, with 17 of 19 buccal advancement flaps showing no dehiscence or chronic sinusitis and all 24 buccal fat pad grafts showing no dehiscence, with no continued sinus complaints. Complications ranged from a sensation of tightness in the graft area to paresthesia of nerve V2. There was no statistical difference in results between buccal fat pad grafts and buccal advancement flaps.

The results of this study infer that a combined approach to the multifactorial disease process results in a very successful and predictable outcome.