How To: Oroantral Fistula Closure Using Double-Layered Flap

by Beatriz Arana-Fernández, MD, Alfonso Santamaría-Gadea, MD, PhD, Fernando Almeida-Parra, MD, PhD, and Franklin Mariño-Sánchez, MD, PhD •

OAF was visualized transorally and the mucosal edges were freshened by removing 1 mm of the margin. From above, a guide point with VICRYL 4/0 was made to the GPA flap close to its anterior edge to facilitate its attachment. The flap was introduced through the subtotal medial maxillectomy, and it was placed to cover the left maxillary sinus floor. Then it was sutured to the lateral mucosal edge of the OAF. A BFP flap was made from a vestibular incision and blunt dissection to reinforce the closure and it was sutured to OAF’s edges with four simple 2/0 silk interrupted sutures (Figure 1).

Finally, the inferior turbinated flap was repositioned and sutured with VICRYL 4/0 to its original position. Silicone nasal splints were fixed to the columella and a nasogastric feeding tube was placed and maintained for five days. No intraoperative or immediate postoperative complications were observed. Complete epithelization was observed at six months post-surgery.

RESULTS

Endonasal–transoral management using double-layered flaps such as GPA pedicled flap and BFP achieve infection resolution, maxillary physiological drainage, and closure of medium and large OAF in a single stage with promising results.