Abstract
Although the number of postoperative maxillary cyst (POMC) cases has declined recently, a few reports of refractory cases have also been reported. The indications for endoscopic sinus surgery (ESS) for POMC removal are broadening and attempts to prevent postoperative recurrence at the cyst opening site have been widely investigated. Here, we have advocated our original pedunculated mucoperiosteal flap (CLAP flap; covered lateral and posterior wall flap of the maxillary sinus), where the bony area exposed intraoperatively is covered, to prevent postoperative recurrence. We have also presented the method for creating the CLAP flap. We classified the POMC as being medial, lateral, or anterior superior type and performed ESS. We introduced the CLAP flap after 2015 for the lateral type and some of the medial types of POMCs. We examined the cyst opening rate using computed tomography, age, sex, cyst position, and a follow-up period in four patients (five sides) who did not undergo flap surgery, but who were managed in our hospital in 2015, and in eight patients (nine sides) who underwent the CLAP flap technique in our hospital. In the group with the CLAP flap, the cyst opening rate was significantly higher (P < 0.05). The CLAP flap was effective for preventing postoperative bony regrowth. It may be one of the options for covering the exposed bone surface as widely as possible.
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The datasets during and/or analysed during the current study available from the corresponding author on reasonable request.
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We would like to thank Editage (www.editage.com) for English language editing.
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The study protocol was approved by the ethics committee of Dokkyo Medical University Saitama Medical Center (Authorization No. 1736).
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The CLAP flap (covered lateral and posterior wall flap of the maxillary sinus) was used in combination with the inferior meatus lateral flap in all cases.
In both flaps, the pedicle is located behind the nasal cavity, with the sphenopalatine artery acting as the main feeding vessel. The cyst is located laterally, outside the infraorbital nerve.
Left nostril: The cyst was released using the endoscopic modified medial maxillectomy approach. The bone surrounding the cyst opening was drilled until there was no overhang.
The mucosa on the lateral side of the inferior turbinate was incised with a slit knife, number 15 scalpel, and scissors, creating the CLAP flap with the dorsal side of the inferior turbinate as the base. The exposed bone was covered by overlaying the CLAP flap and the inferior meatus lateral flap. The nasal cavity configuration is not changed by suturing the inferior turbinate end.
Three months after surgery, computed tomography demonstrated that the cyst opening had good patency and no bony regrowth. The endoscopic findings at 3 months postoperatively showed that the cysts were firmly opened and the flaps were well engrafted.
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Aoki, S., Omura, K., Miyashita, K. et al. A Covered Lateral and Posterior Wall Flap of the Maxillary Sinus Prevents Reocclusion of the Postoperative Maxillary Cyst. Indian J Otolaryngol Head Neck Surg 73, 504–509 (2021). https://doi.org/10.1007/s12070-021-02658-x
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DOI: https://doi.org/10.1007/s12070-021-02658-x