Intra-sinus complex odontoma management simultaneously to oroantral communication closure: Why remove it?

Moacyr Tadeu Vicente Rodrigues,Felipe Germoglio Cardoso Macedo,Filipe Ebenezer De Aguiar Schueng,Claudio Ferreira Noia,Bruno Coelho Mendes,Francisco Nunes Junior

doi:10.33448/rsd-v10i6.15389

Abstract

The oroantral communication is considered one of the most frequent complications in oral surgery, especially in extractions of posterior teeth in the maxilla, treatment of cystic lesions, neoplasms, osteomyelitis and trauma in the region of the maxillary sinus, forming fistulas. However, ectopic third molar and lesions such as odontomas are rarely found simultaneously in the maxillary sinus. This report shows a successful treatment performed in a specific case of oroantral communication, associated to an underdiagnosed complex odontoma and an impacted ectopic third molar into the maxillary sinus and discuss the requirement of intervention. The treatment strategy involved clinical and surgical management through the oroantral communication, avoiding additional bone access to the maxillary sinus. This proposal presented a satisfactory result, and at six months after surgery, the patient has an excellent evolution, proving to be a successful strategy.

Highlights

Oroantral communication (OC) is a communication between the mouth and the maxillary sinus, which may or may not give rise to oroantral fistulas, which are permanently epithelized paths between these cavities (Daif, 2016)
The treatment of cystic lesions, neoplasms, osteomyelitis and trauma to the maxillary sinus region can result in OC (Daif, 2016)
Patients on drug therapy containing bisphosphonates or other drugs with anti-resorptive and anti-angiogenic properties, when submitted to extraction of posterior upper teeth, are at high risk for the development of OC if they develop osteonecrosis in the posterior maxilla induced by such drugs (Greenberg, 2004)

Summary

Introduction

Oroantral communication (OC) is a communication between the mouth and the maxillary sinus, which may or may not give rise to oroantral fistulas, which are permanently epithelized paths between these cavities (Daif, 2016). It is considered one of the most frequent complications in oral surgery, occurring especially in extractions of posterior upper teeth. Considering its rich blood supply, its easy accessibility and its proximity to defects of the posterior maxilla, it is especially indicated for defects larger than 5 mm, often associated with an initial inflammatory condition, frequently found in cases of pre-existing fistulas (Daif, 2016; Park et al, 2019; Yang, Jee & Ryu, 2018). In a case review using PBFPF, Singh, Prasad, Lalitha & Ranganath, (2010) revealed the closure of OC as the main indication of this flap

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