This study aimed to describe the technique and clinical outcomes of using a palatal mucoperiosteal flap for oro-nasal fistula closure following resection of maxillary sinus cancer.
The study was conducted with the permission of the internal review board of the Japanese Red Cross Wakayama Medical Center. Five consecutive cases from 2016 to 2020 of surgically treated maxillary sinus cancer in which the oro-nasal fistulas were closed using a palatal mucoperiosteal flap were retrospectively reviewed.
Following tumor resection, the oro-nasal fistula was closed using a palatal mucoperiosteal flap. Complete separation of the oral and nasal cavities was achieved in four patients. Oral intake was resumed within two weeks in four patients. All the patients were able to eat foods similar to those in the preoperative period. Their postoperative speech function was excellent, with no difficulty in communicating with others.
In the selected cases of maxillary sinus cancer, preservation of the palatal mucosa and closure of an oro-nasal fistula using a palatal mucoperiosteal flap was possible with reasonable outcomes for swallowing and speech functions. The use of this local flap is recommended as a minimally invasive procedure that can be performed especially in patients with limited physiological reserves which preclude free flap reconstruction.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Auris Nasus Larynx
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Treatment of maxillary sinus carcinoma: a comparison of the 1997 and 1977 American Joint Committee on cancer staging systems.Cancer. 1999; 86: 1700-1711https://doi.org/10.1002/(SICI)1097-0142(19991101)86:9<1700::AID-CNCR11>3.0.CO;2-4
- Reconstruction of the maxilla and midface: introducing a new classification.Lancet Oncol. 2010; 11: 1001-1008https://doi.org/10.1016/S1470-2045(10)70113-3
- The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited.Arch Otolaryngol Head Neck Surg. 2001; 127: 837-841
- Wide and/or short cleft palate.Plast Reconstr Surg Transplant Bull. 1962; 29: 40-57https://doi.org/10.1097/00006534-196201000-00006
- Reconstruction following partial maxillectomy incorporating a muco-periosteal island flap.Br J Plast Surg. 1969; 22: 48-52https://doi.org/10.1016/s0007-1226(69)80090-1
- A functional outcome swallowing scale for staging oropharyngeal dysphagia.Dig Dis. 1999; 17: 230-234https://doi.org/10.1159/000016941
- International comparisons of the incidence and mortality of sinonasal cancer.Cancer Epidemiol. 2013; 37: 770-779https://doi.org/10.1016/j.canep.2013.09.014
- Malignant tumors of the maxillary sinus: prognostic impact of neurovascular invasion in a series of 138 patients.Oral Oncol. 2020; 106104672https://doi.org/10.1016/j.oraloncology.2020.104672
- Maxillectomy and its classification.Head Neck. 1997; 19: 309-314https://doi.org/10.1002/(sici)1097-0347(199707)19:4<309::aid-hed9>3.0.co;2-4
- Classification of maxillectomy defects: a systematic review and criteria necessary for a universal description.J Prosthet Dent. 2012; 107: 261-270https://doi.org/10.1016/S0022-3913(12)60071-7
- A classification system and algorithm for reconstruction of maxillectomy and midfacial defects.Plast Reconstr Surg. 2000; 105 (discussion 2347-8): 2331-2346https://doi.org/10.1097/00006534-200006000-00004
- Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects.J Prosthet Dent. 2001; 86: 352-363https://doi.org/10.1067/mpr.2001.119524
- Tunnel technique for the closure of an oroantral fistula with a pedicled palatal mucoperiosteal flap.J Maxillofac Oral Surg. 2015; 14: 868-874https://doi.org/10.1007/s12663-014-0703-z
- Reconstruction of palate with radial forearm flap; a report of 3 cases.Br J Plast Surg. 1990; 43: 350-354https://doi.org/10.1016/0007-1226(90)90087-g
- Benefits of routine maxillectomy and orbital reconstruction with the rectus abdominis free flap.Otolaryngol Head Neck Surg. 1999; 121: 203-209https://doi.org/10.1016/S0194-5998(99)70172-5
- The radial forearm osteocutaneous “sandwich” free flap for reconstruction of the bilateral subtotal maxillectomy defect.Ann Plast Surg. 1998; 40: 397-402https://doi.org/10.1097/00000637-199804000-00013
- The osteocutaneous scapular flap for mandibular and maxillary reconstruction.Plast Reconstr Surg. 1986; 77: 530-545https://doi.org/10.1097/00006534-198604000-00003
- Midface reconstruction with the fibula free flap.Arch Otolaryngol Head Neck Surg. 2002; 128: 161-166https://doi.org/10.1001/archotol.128.2.161
- The systematic review and meta-analysis of free flap safety in the elderly patients.Microsurgery. 2017; 37: 442-450https://doi.org/10.1002/micr.30156
- Palatal island flap for reconstruction of oral defects.Arch Otolaryngol. 1977; 103: 598-599https://doi.org/10.1001/archotol.1977.00780270066010
- Distribution of palatal and other arteries in cleft and non-cleft human palates.Cleft Palate J. 1977; 14: 1-12
- Palatal reconstruction with the palatal island flap.Laryngoscope. 2003; 113: 946-951https://doi.org/10.1097/00005537-200306000-00007
- Extended palatal island mucoperiosteal flap.Arch Otolaryngol. 1985; 111: 330-332https://doi.org/10.1001/archotol.1985.00800070082013
- The palatal island mucoperiosteal flap for primary intraoral reconstruction following tumor ablative surgery.Eur Arch Otorhinolaryngol. 2011; 268: 1633-1638https://doi.org/10.1007/s00405-011-1517-y
- Palatal mucoperiosteal island flaps for palate reconstruction.Arch Craniofac Surg. 2014; 15: 70-74https://doi.org/10.7181/acfs.2014.15.2.70
Published online: June 28, 2022
Accepted: June 17, 2022
Received: March 29, 2022
Grant or other financial support associated with this study: None
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.