Closure of buccosinusal communication with rotation of a palatal flap: case report

Abstract

An buccosinusal communication is an abnormal pathway between the oral cavity and the maxillary sinus. It is usually caused by surgical procedures such as the extraction of premolars and maxillary molars, due to the proximity of the roots to the floor of the maxillary sinus. The aim of this study is to report a surgical treatment for the closure of an buccosinusal communication with the advancement of a palatal flap. The patient was a 45-year-old female adult with no systemic comorbidities and no allergies. She reported pain in the left cheek and nasal discharge. Intraoral examination revealed an area of fistula in the region of element 26 measuring approximately 4-5mm. The CT scan showed a hyperdense image in the left maxillary sinus suggestive of sinus infection and a hypodense image in the region corresponding to the alveolus of element 26, suggestive of an buccosinusal communication. Initially, preoperative laboratory tests were requested and antibiotic therapy was prescribed. Intra- and extra-oral antisepsis, infiltration anesthesia were performed, fistulectomy, demarcation of the palatal flap, incision and full-thickness mucoperiosteal detachment, rotation of the palatal flap to obliterate the fistula and stabilization of the fistula using single-stitch sutures in the raw donor region with fibrin sponges under the suture, for later installation of surgical cement to help protect the wound. The patient is well, with complete closure of the communication and no evidence of post-operative complications.