Management of Oroantral Fistula: Report of Experience at a Teaching Hospital, Northwest Nigeria, and Review of Literature

Oroantral communication (OAC) or fistula (OAF) is an open pathological communication between the oral cavity and maxillary sinus which mostly occurs as a result of extraction of upper molars and premolars, iatrogenic complications or from dental infections, osteomyelitis, radiation therapy or trauma. Several alternative techniques modalities have been described throughout the years for the management of OAC and OAF which show both advantages and limitations. The most employed surgical flaps are of three types: advanced buccal flap, palatal flap and buccal fat pad flap. The authors present two clinical cases: oroantral communication and oroantral fistula, both were treated by using buccal advancement flap.

Oro-antral fistula is an unnatural, pathological and epithelised communication between oral cavity and maxillary sinus. It is mainly due to improper Instrumentation during extraction of maxillary premolars and molars. Closure of oro-antral fistula by suturing of buccal fat pad with palatal flap has shown a high success rate because of its rich vascularity and location. Role of PRF is like icing on the cake in healing of oral defects. PRF (Platelet-Rich Fibrin ) is a healing biomaterial which form a strong natural fibrin matrix which promotes healing. In this case, oro-antral communication was created after the extraction of #16 , which was closed with buccal fat pad along with PRF and monitored until complete epithelisation of socket was achieved. KEYWORDS Buccal fat pad, Platelet rich fibrin, maxillary molars, maxillary sinus, oro antral fistula,

An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. This is an update of a review first published in May 2016. To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 23 May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 4), MEDLINE Ovid (1946 to 23 May 2018), and Embase Ovid (1980 to 23 May 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.

An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. We searched the Cochrane Oral Health Group's Trials Register (whole database, to 3 July 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2015, Issue 6), MEDLINE via OVID (1946 to 3 July 2015), EMBASE via OVID (1980 to 3 July 2015), US National Institutes of Health Trials Registry (http://clinicaltrials.gov) (whole database, to 3 July 2015) and the World Health Organization (WHO) International Clinical Trials Registry Platform (http://www.who.int/ictrp/en/) (whole database, to 3 July 2015). We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.

Background Oroantral communication (OAC) and fistulas (OAF) are pathological openings between the maxillary sinus and the oral cavity. Traditional closure methods, such as buccal or palatal flaps, are effective but can cause postoperative discomfort and tissue loss. Platelet‐Rich Fibrin (PRF), has emerged as a minimally invasive alternative, promoting angiogenesis and tissue healing through the sustained release of growth factors. This study aimed to review the current evidence on the effectiveness of Platelet Rich Fibrin in the management of oroantral communications and oroantral fistulas. Methods A study protocol was developed in accordance with the Preferred Reporting Guideline for Overviews of Reviews (PRIOR) and registered on the International Prospective Register of Systematic Reviews (PROSPERO) under Registration No. CRD 420251027772. Furthermore, the reporting of the present systematic review was performed based on the PRISMA checklist. Results Our search strategy yielded 220 articles from five electronic databases. Of these, 82 were duplicate studies, leaving 138 unique records, which were screened independently by two authors for eligibility. 120 studies were excluded based on title and abstract screening. The remaining 18 full‐text articles were assessed for eligibility. 15 studies were excluded as they did not meet the inclusion criteria. Finally, a total of three systematic reviews met the criteria for inclusion and were critically reviewed. Conclusions This systematic review of systematic reviews highlights the consistent effectiveness of platelet‐rich fibrin (PRF) in the closure of oroantral communications and fistulas, with reported success rates between 90% and 100%. PRF enhanced healing, reduced complications, and improved patient comfort, particularly when used as an adjunct to surgical flaps in larger defects. PRF appears to be a reliable and biologically advantageous material; nevertheless higher‐level studies are needed to confirm its comparative effectiveness and guide clinical protocols.

Aim An oro-antral communication (OAC) represents an abnormal connection between the oral cavity and the maxillary sinus, resulting from dental extractions or implant surgeries, with incidence rates ranging from 0.5% to 13%. If not addressed promptly, OACs can evolve into oro-antral fistulae (OAFs), leading to unpleasant symptoms, such as fluid moving from the mouth into the sinus, with nasal escape, and causing chronic sinusitis. Significant complications such as orbital cellulitis, and potentially severe intracranial infections are possible. We investigate the efficacy of simultaneous combined transoral defect repair and functional endoscopic sinus surgery (FESS) in managing OAFs. Method Data was collected on the cause and OAF duration, pre and post-op medication, 30-day, 3-6 month, and > 12-month outcomes, as well as factors complicating initial diagnosis and the combined approach surgery. Results 15 cases over the last seven years were treated with a combined approach. 11of these were treated for OAF formation secondary to previous dental extraction; the remaining 4 cases were associated with large maxillary-antral pathologies where oroantral communication was an inherent surgical risk. These were therefore not included in the current study. 1/11 post-extraction OAF cases treated with combined approach experienced OAF recurrence and associated sinusitis after 1 year requiring a second procedure. Conclusions Patients treated with a joint approach experienced improved outcomes, with only one recurrence of OAF observed among cases examined. Simultaneous FESS and buccal advancement flap significantly lower postoperative complications as compared to sequential treatments. We advocate this combined approach as the preferred modality for managing OAFs to mitigate long-term sinus-related morbidity.

BackgroundAn oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis.PurposeThis study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure.Patients & MethodsPatients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined radiographically using computed tomography preoperatively. All patients underwent surgical closure of oroantral fistula using a pedicled buccal periosteal flap.ResultsAll 10 patients obtained satisfactory results with marked improvement in the function of the maxillary sinus and complete healing of oroantral fistula with no recurrence except in Case No. 5, who had a recurrence of the oroantral fistula, also there was no statistically significant difference between the vestibular depth preoperatively and postoperatively.ConclusionA pedicled buccal periosteal flap is a novel technique for oroantral fistula closure as it preserves vestibular depth with a tension-free closure flap and harbors the advantages of the regenerative potential of the periosteum.Registration date14/8/2023Registration numberNCT05987943

AimThe aim was to detect the efficacy of combined buccal advancement and palatal rotational flaps in closure of large oroantral fistulas (OAFs) after dental extraction.Materials and methodsA 3-year prospective study was conducted between February 2014 and May 2017. A total of 11 patients with large OAF after dental extraction were included in the study. Seven patients developed OAF after dental extraction of the maxillary first molar teeth, whereas two patients developed an OAF after dental extraction of the second maxillary premolars. The last two patients developed an OAF after dental extraction of the second maxillary molars.ResultsClosure of the defect was achieved in 10 cases, whereas only one case had failure. In addition to postoperative pain, swelling, and reduction of the vestibular sulcus, one patient experienced postoperative nasal adhesions between the nasal septum and inferior turbinate.ConclusionA combined buccal and palatal flap is efficient in closure of large delayed OAF secondary to dental extraction. Further study is required to assess new bone formation after repair of large OAF using this technique.

Oroantral communication is an unnatural communication of the maxillary sinus with the oral cavity, often resulting from dental extractions, infection, trauma, or excision of cysts or tumors. Pathological epithelialization of oroantral communication leads to oroantral fistula.Various techniques have been proposed for surgical closure. Uneventful healing ofthe defect can be achieved in the absence of antral infection. Hence, medical management of maxillary sinusitis should precede surgical closure of the defect. Here, we report a case of an oroantral fistula of the left maxillary third molar, caused by a secondary infection of the extraction site, managed primarily by antibiotics, topical steroids, and irrigating agents followed by surgical closure. It is essential to carefully inspect the post-extraction socket of maxillary teeth due to its high risk of development of oroantral communication. Also, the management of oroantral communications needs early detection to prevent infection and to prevent transforming into an oroantral fistula. In case of an infected oroantral communication or fistula, priority rests on treating the infection first and followed by surgical repair.

Background: Oroantral communications (OACs) are pathological openings between the oral cavity and the maxillary sinus, often resulting from dental extractions. If not treated promptly, they may lead to sinus infections and persistent oroantral fistulas (OAFs).Objective: This report aims to present a minimally invasive technique for the closure of OACs using flowable composite resin stabilized within a network of crossing sutures and to assess its clinical efficacy.Case Descriptions: Two male patients, aged 27 and 31, presented with OACs measuring 8 mm and 6 mm in diameter following maxillary molar extractions. Both cases were managed within 24–48 h postextraction.Intervention: Under local anesthesia, the extraction sockets were sutured using absorbable threads, creating a cross-matrix over the alveolus. Flowable composite resin was then applied into and over this suture network to form a sealing layer. The material was light-cured, and a secondary application was performed following socket curettage to promote stable blood clot formation. In this technique, the flowable composite is mechanically stabilized within the network of crossing sutures, which enhances the retention of the material, ensures effective sealing of the OAC, and supports a more predictable and secured healing process.Outcomes: In both cases, healing was uneventful, with complete closure of the OAC and no signs of sinusitis or fistula formation. Follow-up at 8 and 9 months confirmed successful mucosal healing and radiographic bone regeneration.Conclusion: The fixation of flowable composite within a suture matrix offers a novel, cost-effective, and reproducible technique for the immediate closure of small-to-moderate OACs. This approach enhances mechanical stability, improves sealing, and facilitates predictable healing while avoiding more invasive surgical interventions.

Oroantral fistula (OAF) is a pathological communication between the oral cavity and the maxillary sinus, most commonly resulting from maxillary molar extractions. While traditional surgical techniques such as buccal advancement or palatal flaps have demonstrated efficacy in achieving closure, they may lead to complications including vestibular shortening, mucosal tension, and interference with prosthetic rehabilitation. This case report presents a novel technique for OAF closure involving the mobilization of palatal submucosal tissue anchored to the buccal bone, thereby eliminating the need for buccal flap advancement. Applied in 2 male patients with postextraction OAF, the method preserved soft tissue architecture, reduced surgical morbidity, and facilitated future prosthetic planning. Both patients exhibited complete closure without recurrence or significant postoperative complications. This approach offers a minimally invasive, anatomically respectful, and prosthetically favorable alternative to conventional OAF repair techniques.

Introduction: The oroantral fistula consists of a persistent communication between the maxillary sinus and the buccal cavity, being a complication resulting from traumas, pathologies or dental extractions. Objective: To present a clinical case of oroantral fistula closure using autogenous bone graft from the anterior sinus wall as a treatment option. Materials and Methods: Patient with a history of traumatic extraction of the upper left molars about 4 months ago. During the clinical examination, there was an orifice in the left maxillary alveolar crest, suggestive of oroantral fistula, responding positively to the Valsalva maneuver. Panoramic radiographic examination evidenced continuity between the oral cavity and the left maxillary sinus, which presented with opacification, suggestive of acute maxillary sinusitis on the left side. Sinusitis was treated within 15 days. After treatment, we evaluated the patient who was asymptomatic and, at that moment, the surgical procedure for the oroantral fistula closure was planned, removing a bone block from the anterior wall of the left maxillary sinus presenting the sinus membrane and grafting with fixation using System 1.5 mm with an "L" plate and four bolts. Conclusion: This surgical technique is useful for the closure of chronic oroantral fistulas in patients with oroantral fistulas.Descriptors: Oroantral Fistula; Bone Transplantation; Maxillary Sinus.ReferencesMartín-Granizo R, Naval L, Costas A, Goizueta C, Rodriguez F, Monje F, Muñoz M, Diaz F. Use of buccal fat pad to repair intraoral defects: review of 30 cases. Br J Oral Maxillofac Surg. 1997;35(2):81-4.Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula:experience with 27 cases. Am J Otolaryngol. 2003;24(4):221-23.Anavi Y, Gal G, Silfen R, Calderon S. Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):527-34.Haas R, Watzak G, Baron M. A preliminary study of monocortical bone grafts for oroantral fistula closure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(3):263-66Zide MF, Karas ND. Hydroxylapatite block closure of oroantral fistulas: report of cases. J Oral Maxillofac Surg. 1992;50(1):71-5.Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R. Closure of oroantral communications with Bichat's buccal fat pad. J Oral Maxillofac Surg. 2009;67(7):1460-6.Jain MK, Ramesh C, Sankar K, Lokesh Babu KT. Pedicled buccal fat pad in the management of oroantral fistula: a clinical study of 15 cases. Int J Oral Maxillofac Surg. 2012;41(8):1025-29.Amaratunga NA. Oro-antral fistulae--a study of clinical, radiological and treatment aspects. Br J Oral Maxillofac Surg. 1986;24(6):433-37.Proctor B. Bone graft closure of large or persistent oromaxillary fistula. Laryngoscope 1969;79(5):822-26.Visscher SH, van Minnen B, Bos RR. Closure of oroantral communications: a review of the literature. J Oral Maxillofac Surg. 2010;68(6):1384-91.Visscher SH, van Roon MR, Sluiter WJ, van Minnen B, Bos RR. Retrospective study on the treatment outcome of surgical closure of oroantral communications. J Oral Maxillofac Surg. 2011;69(12):2956-61.Hanazawa Y, Itoh K, Mabashi T, Sato K. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg. 1995;53(7):771-75.

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Oral Health's Trials Register, the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organisation International Clinical Trials Registry Platform. There were no restrictions on language or date of publication selected.Study selection Randomised controlled trials (RCTs) of interventions for the management of oro-antral fistulae or communications as a result of dental procedures only were considered. Crossover trials and quasi-randomised studies were excluded. Data extraction and synthesis Two reviewers independently elected studies, extracted data and assessed risk of bias. The main outcome of closure of the oro-antral fistulae or communications was dichotomous and expressed as a risk ratio (RR) 95% confidence intervals (CI). The GRADE approach was used to assess the overall quality of the evidence.Results Only one study with unclear risk of bias was included. This involved 20 patients and compared two surgical interventions: pedicled buccal fat pad flap and buccal flap. There was successful closure of all oro-antral communications in both groups, so no difference was reported between the interventions one month after surgery (RR 1.00, 95% Cl 0.83 to 1.20). The quality of the evidence was very low (GRADE). Conclusions As all the interventions in the one small study were effective there is insufficient evidence to assess any difference. Further research including large well-conducted and reported RCTs on treating oro-antral communications and fistulae caused by dental procedures is needed to inform clinical practice.

Objective: The Rehrmann flap is a type of buccal flap for closure of small oro-antral fistula (OAF). The aim of the study was to investigate whether the subperiosteal scoring contributes to enhanced success of Rehrmann flap for closure of OAF. Methods: The prospective randomized study was undertaken on 40 patients who had previously undergone extraction of maxillary first molars with an established diagnosis of OAF. The patients were divided into 2 groups of 20 cases each with OAF following extractions and surgical closure based on “with subperiosteal scoring” for group A and “without subperiosteal scoring” for patients included for group B intervention arm. Results: It was observed that for patients in group A, there was adequate tissue for OAF closure without flap tension in 20 patients (100%), whereas for patients in group B, flap closure without tissue tension could be achieved in 10 of the 20 patients (50%). The incidence of postoperative flap dehiscence was n = 1 (5%) in group A and n = 7 (35%) in group B. Conclusion: Subperiosteal scoring was found effective and had a better and uneventful healing of oro-antral communication or fistula. Cite this article as: Bhargava D, Beena S, Kangloo S, Gupta M, BhargavaG P, Shrivastava S. Does subperiosteal scoring contribute to enhanced success of Rehrmann flap for closure of oro-antral fistula? Essent Dent. 1(2):49-54.

Foreign bodies in paranasal sinuses are very rare and most of them are encountered in the maxillary sinus. These foreign bodies may be organic or inorganic and can enter the maxillary sinus through an oro-antral fistula. The oro-antral fistula is formed by a break in the bony segment of the maxillary sinus floor and usually arises subsequent to maxillary premolar and molar extractions. A 63-year-old female patient evaluated for a nonhealing, left, toothless palate lesion and chronic headache occurring over 4 years. Radiography and computed tomography revealed bone discontinuity in the left floor of the maxillary sinus and calcifications within the antrum. A blue foreign body, later identified as dental impression material, was removed by intranasal endoscopy. A careful oral examination is recommended prior to prosthetic restorations. In addition, paranasal sinus foreign bodies should be surgically removed to prevent secondary soft tissue reactions.