OROANTRAL FISTULA - A COMPLICATION OF TRANSANTRAL LIGATION OF THE INTERNAL MAXILLARY ARTERY FOR EPISTAXIS

Transantral ligation of the internal maxillary artery (IMAX) is a well -described option for surgical management of posterior epistaxis not c ontrolled by anterior and posterior packing. Advocates for this proced ure argue that it reduces the morbidity, length of hospital stay and f inancial cost associated with prolonged nasal packing. The procedure i s carried out through a Caldwell-Luc approach and the IMAX is clipped in the pterygomaxillary fossa. Fashioning of a nasoantral window is op tional and its inclusion usually depends on the integrity of the sinus ostium. The commonest complications of transantral IMAX ligation occu r when local structures including the inferior orbital and anterior su perior alveolar nerves are damaged. The incidence of oroantral fistula following IMAX ligation is very low but those cases reported have bee n associated with the failure to create a nasoantral drainage window. We report two cases of persistent oroantral fistula complicating trans antral internal maxillary artery ligation. No nasoantral window was fa shioned in either of these cases.