Is inferior meatal antrostomy still relevant? A 12-year analysis of 93 oroantral fistulae closure with concomitant Caldwell-Luc operations.

OBJECTIVE: The aim of this study was to retrospectively evaluate clinical outcomes after closure of oroantral fistulae with concomitant Caldwell-Luc operations (OFCLOs) with or without inferior meatal antrostomy (IMA). STUDY DESIGN: Records from consecutive OFCLOs carried out over a 12-year period at the oral and maxillofacial surgery department at a single medical center were reviewed. Background data included age, sex, medical status, indications, and etiologies. Outcome data included operative time, hospitalization time, and postoperative use of analgesics and complications. RESULTS: From 2002 to 2013, 54 male patients (58%), 39 female patients (42%) (mean age 50 years; range 12-84 years) underwent OFCLOs. IMA was carried out in 66 cases (70%). All patients had minimal complications. We found statistically significant shorter operating times (72 vs 84 minutes), shorter postoperative hospitalization times (4.1 vs 5.6 days), lower need of analgesics (1.44 vs 2.88 per day), and fewer complications (11% vs 38%) when IMA was not used. CONCLUSIONS: IMA during OFCLOs carries increased morbidity without apparent benefits. Its routine use should, therefore, be discontinued.

Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers.

Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients' demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.