Sinus lifting and reconstruction of localized alveolar defects are often required after closure of a large oroantral fistula (OAF) to allow for subsequent implant installation. This study describes a combined surgical technique that involves sinus lifting, bony closure, and reconstruction of the alveolar defect at the site of an OAF. The sinus membrane was reconstructed as a continuous layer by combining the residual sinus membrane with a rotated part of oral mucosa around the OAF. Autogenous bone from the chin and/or ramus was grafted into the prepared sinus space and alveolar defect, and the graft was covered by a buccal advancement flap. This technique was used to treat 8 patients who had large OAFs in the posterior maxillary region. The treatment was successful in all cases, and the technique appears to be suitable for large OAFs where implants are subsequently desired.

Objective: To determine the optimum surgical treatment for oral antral communications (OAC) and to understand the main post-operative complications. Study Design: Meta-analytical, observational and retrospective study of 1.072 cases of OAC obtained from a literature review of 15 articles. Results: OAC occur slightly more often in men and during the fourth decade of life. Its primary etiological factor is dental extraction, most often affecting the third molar. The most common treatment has been the use of Bichat's fat pad grafts, whereas the technique with the highest percentage of complications has been the use of the palatal rotation flap. The most frequent complication has been the fistulization of the OAC. Conclusions: Early diagnosis of OAC and its treatment within 48 hours of evolution are fundamental in order to properly resolve this pathology. The use of Bichat's fat pad grafts is a simple technique that offers excellent vascularization and results.

Abstract The sinus elevation procedure is a predictable technique to allow for placement of dental implants in the posterior maxilla when the height of the alveolar ridge is limited. The sinus elevation can be performed by various techniques. In the crestal approach, bone graft is utilized to hydraulically elevate the sinus membrane through an osteotomy prepared in the alveolar crest. The implant can be placed either immediately or at a later surgery. This is a case report of an oroantral communication that developed as a complication to a sinus elevation surgery performed with the crestal approach. A 54-year-old female patient presented for dental implant treatment. The patient reported sleep apnea and smoking. Full-thickness flap was reflected in the posterior maxilla and using trephines, an osteotomy was prepared, 1 mm short of the sinus. The trephined core of bone was pushed into the sinus using osteotomes. Particulate bone graft was introduced through the osteotomy to elevate the sinus membrane, and a collagen membrane was used over the bone graft. Six days after surgery, the patient returned to the clinic with an oroantral communication. The patient reported that she was using a positive-pressure breathing mask at night because of sleep apnea. A flap was extended to the tuberosity area and was rotated palatally to achieve closure. The use of the pressure breathing mask was discontinued. The oroantral communication was successfully closed. Relatively few complications have been reported using the osteotome sinus elevation technique. The use of a positive pressure mask may have complicated a sinus elevation surgery. Other factors that may have contributed to this complication include smoking and delayed healing of the area.

Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.

OBJECTIVE: The objective of this study was to report results of functional endoscopic sinus surgery (FESS) for treatment of chronic maxillary sinusitis of dental origin in a series of patients with oroantral fistulae (OAF). STUDY DESIGN: Fourteen patients were treated by FESS and OAF closure by local flap. Data on severity of symptoms, diagnostic endoscopy, and coronal CT scan findings, as well as intraoperative course and complications, were recorded. The follow-up period lasted up to 2 years, comprising clinical examinations and control CT scans. RESULTS: All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical examinations and control CT scans. No significant complications were recorded. No revision surgery was needed in any case. CONCLUSION: These results indicate that FESS, combined with OAF closure by buccal flap, might be an effective and safe option for treatment of selected cases of chronic odontogenic sinusitis with OAF.

OBJETIVE: To analyze characteristics, clinical evolution and surgical techniques of oroantral communication (OAC). STUDY DESIGN: We included all patients operated at the University Central Hospital (Oviedo, Spain) between 1996 and 2007. The variables assessed were age, sex, medical history, OAC size, sinus disease, surgical technique, duration of hospitalization and post-surgical evolution. RESULTS: We analyzed 12 patients (7 men and 5 women) with an average age of 47.5 years. The most frequent cause of oroantral communication was the extraction of the first upper molar. The average size of fistula was 0.9 cm. Buccal flap repair was used in 7 patients, palatal rotation-advancement flap in 4 patients and buccal fat pad in only one patient. Suture dehiscence was observed in one patient treated with a palatal flap, but no additional surgery was required. Three OAC recurred; all of them following a buccal flap procedure. All recurrences spontaneously closed between one and four months following the procedure. CONCLUSIONS: OACs are rare complications and treatment should be individualized to avoid further complications.

UNLABELLED The oroantral fistula is a pathological connection between the maxillary sinus and with the oral cavity. The condition mostly follows dental extraction. AIM To present the experience of 25 cases. MATERIAL AND METHODS Retrospective cases between 1996-2000. The ORL examination included nasal or sinusal endoscopy, a CT scan and histopathological analysis. RESULTS Twenty-five cases were found: ten 2nd molar cases, eight 1st molar cases, six 2nd premolar cases, and one canine case. All patients underwent a Caldwell-Luc operation plus excision of the epithelium lining the fistula, that was then completely covered by a flap of mucosa rotated from the genian region. DISCUSSION In cases of major fistulae a bone autograft taken from the anterior sinus wall was used. Bacterial cultures (n=19) revealed streptococus pneumoniae (13), haemophillus influenza (6), Moraxella catharralis (2) and staphylococus aureus (2). Aspergillus niger was found in one case presenting as a "fungic ball". CONCLUSIONS The only case of surgical failure, after 30 days postoperatively, was reoperated, using a bone graft. After a 6-month follow up all of the patients progressed satisfactorily, including the reoperated patient.

Bone grafts to the maxillary sinus are often required after closure of an oroantral fistula (OAF) to allow for subsequent implant installation. This report describes a single procedure that closes a large OAF using bone grafting to the involved sinus. This technique involves sinus mucosal lifting via elevating the sinus membrane, which is recovered as a continuous layer by combining the residual sinus membranes with a rotated part of oral mucosa around the OAF. Autogenous bone from the ilium was grafted into the prepared sinus space, and the oral side of the graft was covered by a rotated palatal flap. This technique was used to treat 3 patients who had large OAFs in the atrophied posterior maxillary region owing to previous multiple implant failures after sinus lifting. The treatment was successful in all cases. This technique appears to be suitable for large OAFs where implants are subsequently desired.

OBJECTIVES The purpose of this case series was to describe late complications of maxillary sinus augmentation procedures, including paranasal sinusitis and oroantral fistula, and to discuss the definitive surgical methods of treatment. STUDY DESIGN The case series included 13 patients hospitalized for a failed lateral-approach maxillary sinus augmentation, performed by a dental practitioner, with or without simultaneous implant placement. Data on patient gender and age, presenting signs and symptoms, radiographic appearance, method of repair, and follow-up were recorded. RESULTS There were 7 female and 6 male patients aged 53-74 years. Twenty-six of the total 34 implants inserted failed, of which 7 were displaced into the sinus. All patients had maxillary sinusitis, and 2 also had an inflammation of other paranasal sinuses. Ten patients presented with an oroantral fistula. Review of the files of the referring practitioner revealed the preoperative presence of chronic maxillary sinusitis in 4 patients and an odontogenic cyst in 1. Caldwell-Luc operation served as the definitive surgical treatment. All fistulas were successfully closed by a palatal rotation advancement flap (8 patients) or a buccal flap (2 patients). CONCLUSIONS Thorough clinical and radiographic evaluation is necessary before sinus procedures to minimize complications. Total elimination of sinusitis and other pathologic conditions is recommended before maxillary sinus augmentation and implant surgery.

The roots of molar and premolar maxillary teeth are often very close to the floor of the maxillary sinus. As a result, extraction of these teeth can leave an oral-antral communication or lead to a fistula that requires treatment. A woman with an oral-antral communication secondary to extraction of a maxillary molar is presented. The communication was closed by means of a bone graft harvested from the wall of the sinus (zygomatic bone). After 3 months, 2 dental implants were placed, one in the pterygoid area and the other with parasinusal angulation. Rehabilitation followed in the form of a screw-retained, fixed prosthesis 3 months after implant placement. There have been no complications after 1 year of follow-up. This surgical technique allowed closure of an oral-antral communication produced by molar extraction through placement of a zygomatic bone graft and subsequent placement of 2 dental implants.

To evaluate disease dynamics, treatment results, and frequency of malignant transformation. Ten-year single center retrospective study. The study included 171 patients, 28-99 years old. Follow-up was 1-16 years. 49.5% exhibited changes in clinical presentation, with 19% yearly increase of probability for type shift. Index of extent (number of oral locations) showed a mean 40% decrease and 94.1% reported improvement. There were significant differences between treated and untreated patients (P=0.012). Patients with or without systemic diseases had identical treatment requirements for oral lesions. The prevalence of SCC was 5.8%. Oral lichen planus constantly changes presentation and extent of involvement. The effect of systemic diseases was insignificant in the present study. There is a clear value for treatment to reduce the extent of lesions. The results indicate that all clinical forms of the disease need to be equally followed since the clinical presentation typically changes over time, while malignant transformation can occur in all forms.

PURPOSE To investigate the correlation between clinical characteristics, radiologic features, treatment modalities, and treatment outcome of glandular odontogenic cyst, and to suggest a treatment protocol based on these results. PATIENTS AND METHODS The study included a total of 56 cases, 49 from the literature and 7 new cases. Demographic data, locularity and radiographic extension, cortical plate integrity, treatment modalities, follow-up, and recurrence were analyzed. RESULTS There were 34 male and 22 female patients aged 14 to 74 years (mean, 48 years). The mandible was involved in 41 cases (73.2%) and the maxilla in 15 (26.8%), predominantly in the anterior region; 53.6% of the lesions were unilocular and 46.4% multilocular. Large lesions were found in 78.5% of cases. Cortical integrity was compromised in 53.6%(cortical perforation in 39.3% and thinning or erosion of the cortical plate in 14.3%). Recurrence occurred at a rate of 29.2%, within 0.5 to 7 years (mean, 2.9 years). Mean follow-up was also 2.9 years. Two patients had 3 recurrences each. Recurrence was associated with minor surgery such as enucleation or curettage; none of the patients treated by peripheral ostectomy, marginal resection, or partial jaw resection had a recurrence. Compared with the patients without recurrence, the recurrence group had a higher frequency of multilocularity than the nonrecurrent group (64.3% vs 41.2%) and of compromised cortical integrity (71.4% vs 47.1%). CONCLUSION Glandular odontogenic cyst is an aggressive lesion. Treatment by enucleation or curettage alone is associated with a high recurrence rate. Small unilocular lesions can be treated by enucleation. In large uni- or multilocular lesions, an initial biopsy is recommended. Surgical treatment of large lesions should include enucleation with peripheral ostectomy for unilocular cases and marginal resection or partial jaw resection in multilocular cases. Marsupialization followed by second phase surgery is an option for lesions approaching vital structures. Follow-up should continue for at least 3 years (up to 7 years in cases with features associated with increased risk).

Abstract Objective: To establish the efficiency of micro-computed tomography (microCT) in detection of trabecular bone remodeling of onlay grafts in a rodent calvaria model, and also compare bone remodeling after onlay grafts with beta-tricalcium phosphate (TCP) or coral calcium carbonate. Study Design: Ten rats received calvarial onlay blocks, five with beta-tricalcium phosphate (TCP) and five with coral calcium carbonate. The grafts were fixed with a titanium miniplate screw and covered with a collagen resorbable membrane. Three months after surgery, the calvaria were segmented and a serial 3-dimensional microCT scan of the calvarium and grafted bone block at 16 micrometer resolution was performed. Image analysis software was used to calculate the percentage of newly formed bone from the total block size. Results: Newly formed bone was present adjacent to the calvarium and screw in all specimens. The mean area of newly formed bone out of the total block size ranged 34.67-38.34% in the TCP blocks and 32.41-34.72% in the coral blocks. Conclusion: In the TCP blocks bone remodeling was found to be slightly higher than in coral blocks. MicroCT appears to be a precise, reproducible and specimen nondestructive method for analysis of bone formation in onlay block grafts to rat calvaria.

We present a family segregating for an autosomal dominant syndrome of hypotelorism, cleft palate/uvula, high-arched palate and mild mental retardation. Although these findings may suggest a form of holoprosencephaly, no holoprosencephaly was found on MRI of the proposita. Results of genetic studies were normal including FISH for deletion of 22q11, karyotype analysis, fragile X testing, high-resolution comparative genomic hybridization and SEPT9, SHH mutation analysis. The syndrome is reminiscent of the infrequently recognized autosomal dominant Schilbach-Rott syndrome.(c) 2009 Wiley-Liss, Inc.

OBJECTIVES To characterize the clinical manifestations of Actinomyces-associated lesions of the oral mucosa and jawbones, and to correlate the clinical course and treatment requirements with the findings of histomorphometric analysis. STUDY DESIGN The study was a 10-year retrospective analysis of archived cases with microscopic identification of Actinomyces infection. Actinomyces colonies were identified, using hematoxylin-eosin, Gram, and periodic acid-Schiff stains, exhibiting filamentous morphology with color variation between center and periphery. Only colonies with adjacent tissue reaction (inflammation, fibrosis) were analyzed. Actinomyces density (AD) was calculated by dividing total number of colonies by tissue surface, Actinomyces relative surface (ARS) was calculated by dividing total bacterial surface by tissue surface. RESULTS The study included 106 cases (48 male, 58 female; aged 13-84 years, mean 50.5 years). Cases presented a wide clinical spectrum, involving jawbone and/or oral soft tissues. Cases included osteomyelitis associated with bisphosphonates, osteoradionecrosis, osteomyelitis unrelated to radiation or bisphosphonates, periapical lesions, odontogenic cysts, periimplantitis, and lesion mimicking periodontal disease. The AD correlated with median length of antibiotic treatment (R = 0.284; P =.028). CONCLUSIONS Because we were able to identify 106 such cases, the results indicate that Actinomyces-associated lesions may not be as rare as would be expected from the relatively low number of cases in the literature. Actinomyces-associated lesions presented in a wide spectrum of clinical settings and a variety of contributing factors. Quantitative analysis of the number of bacterial colonies (representing bacterial load) could help in evaluating the aggressive potential of the lesion and help in treatment planning.

OBJECTIVES The aim was to evaluate the effectiveness of the long-term administration of intranasal calcitonin spray for the treatment of central giant cell granuloma (CGCG) in a retrospective case study. STUDY DESIGN The medical files of 5 patients (4 male, 1 female; ages 8-66 years) with CGCG of the jaws treated with calcitonin nasal spray 200 U/spray once or twice daily were reviewed for lesion-related parameters, outcome, and adverse effects of therapy. RESULTS Three lesions were located in the mandibular body and ramus region and 2 in the anterior maxilla. Mean lesion size on radiography was 3.2 x 2.3 cm. The duration of calcitonin treatment was 9-60 months (mean 28 months). All the lesions considerably decreased in size with a high degree of calcification. There were no recurrences. CONCLUSIONS Calcitonin nasal spray appears to be safe and effective for the treatment of CGCG and might be considered an alternative to surgery. Further controlled studies are needed to corroborate these findings.

OBJECTIVES The purpose of this case series was to describe late complications of maxillary sinus augmentation procedures, including paranasal sinusitis and oroantral fistula, and to discuss the definitive surgical methods of treatment. STUDY DESIGN The case series included 13 patients hospitalized for a failed lateral-approach maxillary sinus augmentation, performed by a dental practitioner, with or without simultaneous implant placement. Data on patient gender and age, presenting signs and symptoms, radiographic appearance, method of repair, and follow-up were recorded. RESULTS There were 7 female and 6 male patients aged 53-74 years. Twenty-six of the total 34 implants inserted failed, of which 7 were displaced into the sinus. All patients had maxillary sinusitis, and 2 also had an inflammation of other paranasal sinuses. Ten patients presented with an oroantral fistula. Review of the files of the referring practitioner revealed the preoperative presence of chronic maxillary sinusitis in 4 patients and an odontogenic cyst in 1. Caldwell-Luc operation served as the definitive surgical treatment. All fistulas were successfully closed by a palatal rotation advancement flap (8 patients) or a buccal flap (2 patients). CONCLUSIONS Thorough clinical and radiographic evaluation is necessary before sinus procedures to minimize complications. Total elimination of sinusitis and other pathologic conditions is recommended before maxillary sinus augmentation and implant surgery.

The behavior of adenoid cystic carcinoma (ACC) of the salivary glands has been shown to be unpredictable in terms of local and distant spread and mortality. We retrospectively studied 35 operations in 34 patients who had had a pathologic diagnosis of ACC of the salivary glands and who had been treated over a 20-year period and followed for a minimum of 10 years. We analyzed the effect that different factors had on outcomes. The site of origin appeared to be an important factor in survival rates; survival among patients with tumors that had originated in the parotid gland was fairly good, while survival among those with tumors that originated in the minor salivary glands was significantly worse. TNM staging was another significant factor in survival. Other poor prognostic indicators were local spread, nodal positivity, distant metastasis, and local and regional recurrence. Radiation and chemotherapy did not appear to be beneficial for patients with advanced disease. We recommend radical surgery with complete resection for all patients with ACC of the salivary glands and a careful assessment of the neck in patients with minor salivary gland tumors.

(1) To investigate the use of p53, Ki67, and PCNA as an aid in the diagnosis of glandular odontogenic cyst (GOC);(2) To compare the expression of these markers in GOC, low-grade mucoepidermoid carcinoma (MEPCa), and radicular cyst with mucous metaplasia (RCM) as an aid in the differential diagnosis;(3) To establish guidelines for the diagnosis of GOC. Study group: 35 patients: 10 GOC, 15 RCM, 9 MEPCa. Immunostaining of archival specimens for p53, Ki67, PCNA. Twenty-nine articles (1987-2004) with detailed histopathological descriptions of GOC, analyzed for frequency of histopathological characteristics. Mean p53 labeling index (LI) was higher in GOC (3.0+/-4.3%) and MEPCa (4.9+/-7.4%) than in RCM (0.4+/-1.2%, p=0.048). Ki67 LI was higher in GOC (4.4+/-4.7%) and RCM (3.7+/-6.7%) than in MEPCa (0.7+/-1.6%, p=0.03). There were no significant differences in the expression of PCNA. In the literature, the most consistent histopathological characteristics of GOC included epithelial spherules/"knobs"/whorls (82.8%), cuboidal eosinophilic cells (65.5%), goblet cells (65.5%), intraepithelial glandular/microcystic ducts (58.6%), variations in lining width (55.2%), ciliated cells (51.7%) and mucous pools/mucous-lined crypts (41.4%). These histopathological features were divided into major and minor signs. The diagnosis of GOC should be based on at least the focal presence of the major signs. Measurement of p53 and Ki67 may aid in the differential diagnosis of GOC.

OBJECTIVES Clear cells have been reported in approximately 8% of cases of calcifying epithelial odontogenic tumor (CEOT). The purpose of this study was to describe the clinical and radiographic features of clear-cell CEOT (CCEOT). STUDY DESIGN Eighteen cases of CCEOT were identified by review of the literature from 1958 to 2001, and a new one was added (total 19; 12 central, 7 peripheral). RESULTS Fourteen tumors (74%) were located in the mandible, with the central lesions favoring the posterior area and the peripheral lesions the anterior-bicuspid area. Radiographic features were as follows: 50% radiolucent, 50% mixed radiolucent-radiopaque; 92% unilocular; 64% well-defined noncorticated borders, 27% well-defined corticated borders, 9% irregular borders. Cortical perforation was common (67%) compared with CEOT without a clear-cell component (6.7%). Recurrence was reported in 17% of the central lesions and none of the peripheral ones. CONCLUSIONS CCEOT is a distinct variant of CEOT; its high tendency for cortical perforation may indicate a more aggressive behavior.

PURPOSE We evaluated the long-term success rate of an abdominovaginal approach using a rotational bladder flap to repair giant vesicovaginal fistula. MATERIALS AND METHODS A total of 35 patients were included in this study. Of these patients 28 had a large vesicovaginal fistula and 7 had complete loss of the urethral floor. Fistula etiology was secondary to obstructed labor in 25 patients, the result of iatrogenic surgical injuries in 5, sling erosion in 3 and pelvic irradiation in 2. Using combined abdominal and vaginal approaches the bladder was bisected sagittally, and a bladder flap was rotated downward and medially to fill the extensive fistula defect. An additional vascularized flap was interposed in 23 patients including gracilis muscle flap in 13, omental flap in 5, peritoneal flap in 2 and Martius flap in 3. RESULTS Fistulas were successfully repaired in 31 of 35 patients (88%). The remaining 4 patients underwent surgical correction with a second, more limited repair. This group included 2 patients with fistula from obstructed labor, 1 due to sling erosion and 1 due to irradiation. CONCLUSIONS A combined abdominovaginal approach with the use of a generous rotational bladder flap for repair of a complex vesicovaginal fistula allowed for excellent results. There was a high success rate on the first attempt due to the excellent exposure and healthy, well vascularized tissue used for repair.

OBJECTIVE Palatal fistulation is a common complication after cleft palate repair, it could occur at any site along the line of cleft closure. Many techniques have been proposed for its repair. However, the incidence of recurrence after initial fistula closure is high. The aim of this study is to evaluate the efficacy of closure of posterior palatal fistula using buccal myomucosal flap. METHOD Fifteen cases with posterior palatal fistulas - after cleft palate repair - were included in this study. Their fistulas were closed in two-layers; an oral mucoperiosteum hinge flap to reconstruct the nasal side and a buccal myomucosal flap from the inner surface of the cheek to reconstruct the oral side. Follow-up was carried out for 1 year. RESULTS The fistulas were completely closed in all cases (100%) with no failure or recurrence. This was a single-stage operation in all cases, with no need for further procedure to divide the pedicle of the flap. CONCLUSIONS Closure of posterior palatal fistula using buccal myomucosal flap in addition to mucoperiosteal flap is a useful method with high success rate and no morbidity.

UNLABELLED The oroantral fistula is a pathological connection between the maxillary sinus and with the oral cavity. The condition mostly follows dental extraction. AIM To present the experience of 25 cases. MATERIAL AND METHODS Retrospective cases between 1996-2000. The ORL examination included nasal or sinusal endoscopy, a CT scan and histopathological analysis. RESULTS Twenty-five cases were found: ten 2nd molar cases, eight 1st molar cases, six 2nd premolar cases, and one canine case. All patients underwent a Caldwell-Luc operation plus excision of the epithelium lining the fistula, that was then completely covered by a flap of mucosa rotated from the genian region. DISCUSSION In cases of major fistulae a bone autograft taken from the anterior sinus wall was used. Bacterial cultures (n=19) revealed streptococus pneumoniae (13), haemophillus influenza (6), Moraxella catharralis (2) and staphylococus aureus (2). Aspergillus niger was found in one case presenting as a "fungic ball". CONCLUSIONS The only case of surgical failure, after 30 days postoperatively, was reoperated, using a bone graft. After a 6-month follow up all of the patients progressed satisfactorily, including the reoperated patient.

OBJECTIVE (a) Surgical repair of palatal fistulas are technically difficult due to excessive tissue fibrosis with high failure rate.(b) The aim of this study is to evaluate the efficacy of closure of anterior palatal fistula using myomucosal superior lip flap. METHODS 33 cases with anterior palatal fistulas after cleft palate repair were subjected to closure in two-layers, the first is the oral mucoperiosteum hinge flap to reconstruct the nasal side and the second is a myomucosal flap from the inner surface of the superior lip to reconstruct the oral side. Follow up was carried out for 12 months. RESULTS The fistulas were completely closed in 30 cases (91%) and partially closed in 3 cases (9%) due to necrosis of the tip of the flap. CONCLUSIONS Closure of anterior palatal fistula by the use of superior lip myomucosal flap is a useful method with high success rate and no morbidity.

In utilizing free-tissue transfers to reconstruct complex wounds, occasionally a mismatch exists between the donor-flap inflow and the recipient vessel outflow. This occurs more often with fasciocutaneous flaps as opposed to muscle flaps due to their higher resistance. The result of this may be microvascular thrombosis within the system and ultimately flap failure. The creation of an arteriovenous fistula at the distal aspect of the flap may improve the flow dynamics and ultimately salvage the flap. We submit a case of a free osteocutaneous fibular flap used for reconstruction of an ulnar forearm defect. Due to intraoperative thrombosis as a result of flow mismatch, we were able to salvage the flap using a distal arteriovenous fistula. This fistula improved the flow dynamics of the flap by bypassing the high intraflap resistance. An arteriovenous fistula should be kept in the repertoire of the microvascular surgeon as a potential option for flap salvage.

The sub-mental flap has been used in four elderly patients (mean age: 83 years) for reconstruction of defects after oncological resection: three had basal cell carcinoma (cheek, temporal region and fronto-temporal region). One had a squamous cell carcinoma of the hard palate. We believe that the latter example is original and present it in this article. This case shows that the sub-mental flap in addition to its intrinsic qualities is a reliable flap which may be useful in difficult repairs. It can be used to repair wide palatal fistula which occurs after oncological resections.

OBJECTIVE To analyse the indications, diagnosis, major causes and basic principles of surgical treatment of vesico-uterine fistulas (VUF). PATIENTS AND METHODS From 1970 to 2006, 14 patients underwent surgical repair of VUF in two Belgrade hospitals. The most common cause of a fistula was previous Caesarean section (13/14). The mean (range) age was 27 (22-38) years. Five women underwent transvesical fistula suture, and nine underwent a transperitoneal surgical approach with the interposition of a tissue flap; an omental flap in five and a peritoneal flap in four. RESULTS The mean (range) duration of surgery was 85 (70-120) min. The mean hospital stay was 14 (12-22) days. The urethral catheter was removed 10 days after surgery. One woman with no tissue flap repair relapsed and none of the women with a tissue flap repair relapsed. After surgery, eight patients became pregnant and underwent Caesarean section. CONCLUSION Successful closure of VUF requires accurate diagnostic evaluation, appropriate repair using techniques that utilize basic surgical principles, and the careful application of interposing tissue flaps.

Postoperative oronasal fistula in cleft palate repair is common and usually repaired with local flaps or buccal flaps with some benefits. Considering the high recurrence rate after surgery, a new method for oronasal repair using septal flaps is described.

Palatal obturators are frequently used in the initial treatment of postoperative palatal fistulae to address the associated problems experienced with speech and swallowing. Many reconstructive surgical techniques for palatal defects have been reported. Although palatal-based flaps are less frequently reported, they can offer a relatively simple reconstructive option with minimal morbidity in patients with acquired palatal defects. We present a case report of a patient requiring reconstruction of a midline oronasal fistula after resection of a palatal malignancy and review the literature concerning this technique.