SHORT COMMUNICATION Closure of oroantral fistula with the septal cartilage graft Leyla Kansu • Hakan Akman • Sina Uckan Received: 19 June 2010 / Accepted: 7 July 2010 / Published online: 20 July 2010 Ó Springer-Verlag 2010 Abstract For the closure of oroantral fistula, many techniques have been described. There are advantages and disadvantages of all these techniques. We present a tech- nique in which nasoseptal cartilage graft is used for the closure of the oroantral communication. Keywords Closure of oroantral fistula Á Autogenous graft Á Nasoseptal cartilage Oroantral fistula (OAF), an epithelialized communication between the oral cavity and the maxillary sinus, is a clinical complication commonly encountered. The most commonly etiologic factor is tooth extraction [1]. Also it can occur in association with chronic maxillary sinusitis, osteomyelitis, osteoradionecrosis, trauma, the removal of maxillary cysts or tumors, and dental implant failure in the atrophied posterior maxilla [2, 3]. Surgical repair of the OAF is one of the more challenging problems confronting the surgeon working in the maxillofacial region. The multiple tech- niques described in the literature over 50 years point to the lack of consensus for a uniformly successful procedure [3]. Palatal rotation or buccal sliding mucoperiosteal flaps and their modifications are usually used for the surgical closure of OAF. An alternative is the use of the buccal adipose tissue [4]. Although these surgical procedures are easy, they have poor flap perfusion and so not preferred in large bone defects and recurrent fistulas. In addition, autogenous grafts or some alloplastic materials are also used for this purpose. Autologous bone graft can be taken from the iliac crest or mandible. But, bone grafts are resorbed and reduce in volume. Also, harvesting the iliac crest carries the risks of peritonitis, difficulty in walking postoperatively, and problem of sensation [5]. Dura mater and facia lata are used for closing OAF. Attempts to close larger defects caused by severe trauma or tumors by local flaps may lead to failure [1]. Using alloplastic materials can cause complication such as extrusion, migration, infection of the implants or maxillary sinus, and it costs money [6]. In a 44-year-old female patient with nasal septal devi- ation to the left side and oroantral fistula for approximately 20 years, the closure of oroantral fistula with nasoseptal cartilage graft was decided. Under the general anesthesia, incision was made from the right maxillary tuber to the right canine tooth. The epithelial tissue was removed at oroantral fistula surrounding. Oroantral communication was confirmed. The mucoperiosteal flaps were elevated to infraorbital nerve. Large bone defect was seen at maxillary tuber area. The window was opened to anterior maxillary sinus (Fig. 1). The cyst at the right maxillary sinus was removed through Caldwell-Luc approach. The sinus was irrigated with physiological saline solution followed by an iodine containing solution diluted with physiological saline solution to reduce infection. The window was closed with wire. The entrance incision to the nasoseptal cartilage was the hemitransfiction incision. The mucopericondrium was L. Kansu Department of Otolaryngology—Head and Neck Surgery, Baskent University, Ankara, Turkey H. Akman Á S. Uckan Department of Oral and Maxillofacial Surgery, Baskent University, Ankara, Turkey L. Kansu (&) Department of Otolaryngology—Head and Neck Surgery, Alanya Medical and Research Center, Baskent University, Alanya, Antalya, Turkey e-mail: leylakansu@hotmail.com 123 Eur Arch Otorhinolaryngol (2010) 267:1805–1806 DOI 10.1007/s00405-010-1340-x