Oroantral Fistülün Cerrahi Tedavisi: Lokorejyonel Flep Yöntemleri ve Onarım Sonuçlarının Değerlendirilmesi

Yıl 2025, Cilt: 8 Sayı: 4, 501 - 506, 31.12.2025

Comert Sen , Ömer Orak , Vedat Emre Alayoğlu , Said Sönmez , Bora Başaran

https://doi.org/10.36516/jocass.1829621

https://izlik.org/JA55EJ39NE

Öz

Amaç
Oroantral fistül (OAF) onarımında kulak burun boğaz (KBB) pratiğinde kullanılan cerrahi yöntemleri, bu yöntemlerin etiyolojik, demografik ve cerrahi faktörlerle ilişkisini incelemek
Yöntemler
Bu retrospektif kohort çalışmasına, 2007 ve 2024 yılları arasında üçüncü basamak bir KBB kliniğinde cerrahi OAF onarımı uygulanan hastalar dahil edildi. Demografik, etiyolojik ve cerrahi değişkenler ile OAF kapanma başarısı açısından klinik kayıtlar incelendi. Grup karşılaştırmalarında p<.05 anlamlılık düzeyi olarak kabul edildi.
Bulgular
Otuz altı hastaya 40 OAF onarımı gerçekleştirildi. Odontojenik nedenler vakaların %77.5’ini oluştururken, tümöre bağlı etiyolojiler ise %17,5 oranındaydı. Eşlik eden maksiller sinüzit, aynı seansta uygulanan fonksiyonel endoskopik sinüs cerrahisiyle (FESC) tedavi edildi ve vakaların %42,5’inde mevcuttu. Genel olarak 40 işlemin 35’inde (%87,5) başarılı onarım sağlandı; ilk cerrahi işlemde başarısızlık görülen beş hastadan üçünde revizyon cerrahisiyle başarı elde dahildi. Tek flep kullanılan vakalarda bukkal kaydırma flebi ve palatal flep arasında başarı açısından anlamlı bir fark gözlenmedi (%80,0 ile %93,8; p=.333). Tek ve kombine flep teknikleri (%89,3 ile %83,3; p=1.000), greft kullanılan ve kullanılmayan vakalar (%90,0 ile %86,7; p=1.000), FESC yapılan ve yapılmayan olgular (%82.4 ile %91,3; p=.634) arasında da anlamlı bir fark saptanmadı. Yaş, cinsiyet ve sigara kullanımı ile işlem başarısızlığı arasında bir ilişki bulunmadı.
Sonuç
KBB pratiğinde gerçekleştirilen OAF onarımlarında yüksek başarı oranları elde edildi. Sinüs hastalığının kontrol altına alınması ve flep seçiminin fistül özellikleri ve hasta faktörlerine göre kişiselleştirilmesi durumunda hem bukkal hem de palatal flepler fistül onarımında güvenli bulundu. Bu bulgular, OAF yönetiminde diş hekimleri ve KBB uzmanları arasında yakın iş birliğini ve multidisipliner yaklaşımı desteklemektedir.

Anahtar Kelimeler

oroantral fistül , bukkal flep , palatal flep , bukkal yağ yastığı , maksiller sinüzit

Etik Beyan

Çalışma, kurumumuzun etik kurulu tarafından 02.05.2025 tarihinde 2025/654 dosya numarası ile onaylanmıştır.

Destekleyen Kurum

Yazarlar bu çalışmanın herhangi bir finansal destek almadığını beyan etmiştir.

Surgical Management of Oroantral Fistula: Locoregional Flaps and Evaluation of Closure Outcomes

https://izlik.org/JA55EJ39NE

Öz

Aim
To evaluate surgical techniques used for oroantral fistula (OAF) repair in an otolaryngology setting and to assess closure success in relation to etiologic, demographic, and operative factors.
Methods
This retrospective cohort study included patients who underwent surgical repair of OAF at a tertiary otolaryngology unit between 2007 and 2024. Clinical records were reviewed for demographic, etiologic, and operative variables and OAF closure success. A significance threshold of p< .05 was applied for group comparisons.
Results
Thirty-six patients underwent 40 OAF repair procedures. Odontogenic causes accounted for 77.5% of cases, whereas tumor-related etiologies represented 17.5%. Concomitant maxillary sinusitis treated with simultaneous functional endoscopic sinus surgery (FESS) was present in 42.5% of cases. Overall, successful closure was achieved in 35 of 40 procedures (87.5%), including three of five initial failures after revision surgery. Among procedures using a single flap, buccal advancement and palatal flaps yielded similar success rates (80.0% vs 93.8%; p=.333). Success rates did not differ between single and combined flap techniques (89.3% vs 83.3%; p=1.000), between procedures with and without grafts (90.0% vs 86.7%; p=1.000), or between cases managed with or without FESS (82.4% vs 91.3%; p=.634). Age, sex, and smoking were not associated with closure failure.
Conclusion
OAF repair in an otolaryngology setting achieved high success rates. When sinus disease is controlled and flap selection is tailored to defect characteristics and patient factors, both buccal and palatal approaches provide reliable closure. These findings support multidisciplinary management and close collaboration between dental clinicians and otolaryngologists.

Anahtar Kelimeler

oroantral fistula , buccal flap , palatal flap , buccal fat pad , maxillary sinusitis

Etik Beyan

The study was approved by our institutional ethics committee on 02.05.2025 (Approval No: 2025/654).

Destekleyen Kurum

The authors declared that the present study has received no financial support.

Kaynakça

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