Oroantral Fistula Research Articles

Closure of persistent oroantral fistula: Utilizing buccal fat pad, sticky bone, and buccal advancement flap in a three-layered approach – Case report

Oroantral communication (OAC) is a pathological connection between the oral cavity and the maxillary sinus, commonly caused by various factors such as tooth extractions and pathology. Various techniques have been employed to address oroantral fistulae (OAF), predominantly focusing on soft tissue closure and neglecting the bony defect, which is crucial for prosthetic rehabilitation. This case report highlights a novel three-layered closure technique utilizing buccal fat pad (BFP), Guided Tissue Regeneration (GTR) membrane, and a sticky bone graft composed of autogenous and xenograft with i-Platelet Rich Fibrin (PRF), combined with buccal advancement flap and collagen membrane for OAF reconstruction. This innovative approach offers promising outcomes for OAF closure, enhancing patient outcomes and minimizing postoperative complications.

Surgical approach to management of oroantral communications. Case report

Abstract One of the most frequent post-extraction complications of posterior maxillary teeth is oroantral communication, which consists of direct communication between the maxillary sinus and the oral cavity. The recommendation is to make an immediate closure within the first 48 hours to avoid possible complications that may include an oroantral fistula or chronic sinus disease. Currently, different techniques have been described for closing communication, including various types of materials. Some of the techniques are exclusively oriented toward closure, while others seek to achieve bone regeneration by using bone substitutes for the subsequent placement of dental implants. The aim of this study is to describe a simple surgical technique for managing oroantral communication using a collagen sponge with hydroxyapatite and ribose and covering it with overlapping double layers of ribose cross-linked collagen membrane without fixation.

Treatment of Oroantral Communication and Fistulas with the Use of Blood-Derived Platelet-Rich Preparations Rich in Growth Factors: A Systematic Review.

The formation of an oroantral communication (OAC) or fistula (OAF) is a rare complication resulting from the presence of processes in the lateral parts of the maxilla or for iatrogenic reasons. The most common causes of OAC or OAF are tooth extraction with periapical lesions. The aims of this systematic review were to assess the use of platelet-derived preparations rich in growth factors in the treatment of OAC or OAF, to determine the success of treating the communication or fistula, as well as impact on postoperative complications and the course of healing. The study was performed following PRISMA guidelines (PROSPERO: CRD42024570758). The inclusion criteria were as follows: at least ten patients, the presence of oroantral communication or oroantral fistula, treatment with platelet-derived preparations rich in growth factors, and information regarding the response to treatment. In order to find relevant studies, international databases, including PubMed, Google Scholar, Web of Science Core Collection, MDPI, Wiley, and Cochrane Library were searched. The last search was performed on 31 August 2024. Seven articles were included in the systematic review. In total, platelet-derived preparations rich in growth factors were used in 164 patients. Only studies in which OAC was treated and with platelet-rich fibrin (PRF) met the inclusion criteria. Only PRF was used as the sole treatment method in three studies. When OAC is greater than 5 mm, platelet-derived preparations rich in growth factors should be considered adjuncts to treatment, not the sole treatment method. The success rate of OAC treatment was 90-100%. The use of blood products to close OAC may be an effective therapeutic alternative. Proper patient qualification and the use of an appropriate protocol are crucial. There is a need for future well-designed case-control or cohort studies as well as randomized controlled trials to provide the required level of evidence.

A Case of Simultaneous Sinus Augmentation and Oroantral Fistula Closure for Implant Preparation.

An oroantral communication (OAC) may form in the upper molar region after tooth extraction. The patient is a 59-year-old female, who is a non-smoker. At the initial visit, teeth #14, #15, and #17 were missing. After tooth #16 was extracted due to apical periodontitis, a bone defect with a diameter of approximately 4 mm was observed, leading to the formation of an oroantral fistula (OAF). Another window was created in the lateral wall adjacent to the superior part of the bone defect at the fistula site to achieve closure of the OAF through bone formation and simultaneously perform sinus floor elevation (lateral approach) for implant placement. Through this lateral window, instruments were inserted into the maxillary sinus towards the bone defect at the fistula site. During this process, the remaining bone between the lateral window and the bone defect at the fistula site was carefully removed with instruments, connecting the two bone defects to facilitate the manipulation of the instruments. The Schneiderian membrane was elevated without enlarging the tear. Six months after these surgeries, a CBCT scan confirmed the closure of the fistula with hard tissue and the elevation of the sinus floor. Subsequently, three implants were placed, and prosthetic treatment was completed. Follow-up data is provided, including periapical X-ray and CBCT images taken two years and three months after surgery (one year and three months after the placement of the final prosthetic structure). The progress so far has been favorable.

Closure of oroantral fistula with pedicled palatal connective tissue

Closure of oroantral fistula with pedicled palatal connective tissue

Assessment of Treatment Approaches for Oroantral Communication and Fistulas

Objective: The aim of this study was to investigate and compare the treatment methods of large size oroantral defects (OADs) and their clinical outcomes. Material and Methods: The patients who referred our clinic between 2017 and 2023 suffering from oroantral fistula (OAF) and the cases which was occurred oroantral communication (OAC) larger than 5mm during oral procedures were included in the study. The size, type and cause of OAD, treatment method, the patient’s demographic data was recorded. VAS scale, analgesic requirement, the edema, and mouth opening measurements were obtained from preoperative day and postoperative records at 3, 7, 10 days after surgery. Results: 23 patient (8 OAF, 15 OAC) was included in this study. 9 of them was treated with buccal advancement flap (BAF), 10 with buccal fat pad (BFP) and 4 with press-fit technique. No problem was occurred at the healing process. Only in one patient BFP application was failed, and after 2 months second surgery was performed, and the area was fully covered. According to postoperative clinical outcomes, any statistically significance wasn’t observed between groups in the terms of vas scale, analgesic requirement, edema and trismus at any timepoint (p 0.05). Although there was insignificance at all parameters between treatment groups, VAS scale and analgesic requirement was less than BAF and BFP in press fit. Conclusion: BAF, BFP and press-fit methods are reliable and well-known techniques for OAD management, however, further clinical studies with larger sample sizes are needed to create treatment algorithm for OAD.

Oroantral Fistula Reconstruction by Pedicled Buccal Pad of Fat adjuvant with Advancement Flap (Clinical Study)

Aim: As well as highlighting the role of buccal fat of pad in closure large defects by evaluating healing process through pain, swelling and wound healing scores. Material and Method: A prospective evaluation study was conducted among patients who underwent surgical closure to OAC in both Ear Nose and Throat Department with the Maxillofacial Department of Al-Salam Teaching Hospital in Mosul City of Nineveh Province. Data recorded includes demographical Information and clinical evaluations. Two operators measured the parameters. Pain and swelling assessment through the visual analogue scale (VAS) assess the level of pain on the third, seventh and day twenty following surgery. Wound Evaluation Scale used to evaluate closure of the oroantral communication without nasal regurgitation at 1st week (day 7) and 20th days post- surgery and measure the surgical success. Results: The highest age group are between (20-29 years) with percent (56.5). male show high incidence (56.5%) more than female (43.47). In regard to cause extraction followed by tumors are the common cause for oroantral fistula (56.5%, 17.39). Day three and seven reflect different ranges of pain with highest percent for severe pain in day three (65.21%) and reduced to slight pain (82.60%) in day seven. In regard to swelling, in day three most of cases show very severe swelling (73.91%). In day seven the cases represent sever swelling (78.26%). Twenty-one patients from total 23 show incomplete healing at day seven while two patients have uncertain healing. In day 20 just one patient shows incomplete healing process. Conclusion: Buccal pad of fat can be used safely as adjuvant to buccal advancement flap for closure and is efficient in management of OAC to avoid diminished soft tissue in different size cases. Pain, swelling scales can be used as assessment for healing process added to them soft tissue wound healing scale.

Odontogenic Maxillary Sinusitis: A clinical case report

underdiagnosed due to its nonspecific clinical presentation, which overlaps with other types of rhinosinusitis. The etiopathogenesis involves a complex interplay of factors including iatrogenic causes, periodontal infections, and traumatic events, leading to a persistent inflammatory response in the maxillary sinus. This report details a clinical case involving a 19-year-old male patient presenting with exacerbated sinusitis symptoms linked to a carious upper right first molar. Clinical manifestations included blurred vision, facial pain, and nasal regurgitation of liquids. Radiographic analysis revealed a radiolucent area indicative of sinus involvement, confirming the diagnosis of OMS.Surgical intervention comprised the extraction of the infected molar and the debridement of the maxillary sinus, followed by the application of Bichat’s fat pad to repair the resulting oroantral communication. This technique demonstrated effective closure of the defect, promoting tissue healing and reducing postoperative complications. The postoperative regimen included antibiotics, anti-inflammatories, and antihistamines, which facilitated recovery. This case underscores the necessity of a multidisciplinary approach in the diagnosis and management of OMS, integrating dental and surgical expertise to optimize patient outcomes. Imaging plays a crucial role in the diagnostic process, enabling precise identification of odontogenic lesions and their extent. The successful use of Bichat’s fat pad highlights its utility in oral-maxillofacial surgery for managing oroantral fistulas. This report contributes to the growing body of evidence supporting the importance of tailored surgical and medical strategies in managing complex cases of odontogenic maxillary sinusitis.

Retrospective analysis of pathological changes in the maxillary sinus with CBCT

The aim of this study is to examine the frequency of maxillary sinus pathologies and their relationship with each other using cone beam computed tomography (CBCT) and to make a new grade according to the number of affected walls. 1000 maxillary sinuses of 500 patients with CBCT images were included in the study. Anatomical variations and pathological formations of the maxillary sinuses were examined. Images were evaluated for the presence of flat, polypoidal, partial and generalized mucosal thickening, partial and total opacification, polyps and mucous retention cysts. Maxillary sinus pathologies were graded according to the number of walls affected. In the examined CBCT images, no pathology was found in 54.2% of the maxillary sinuses, while pathology was observed in 45.8%. The most common sinus pathologies were mucous retention cyst (12.3%) and polypoidal thickening (12.2%). While pneumatization, ostium obstruction, and the presence of sinus-related roots were associated with sinus pathology, no relationship was found with nasal septum deviation and the presence of septa. Before dental implant and sinus surgery applications, the presence of sinus pathologies and their relationship with anatomical variations can be evaluated with CBCT, a three-dimensional technique, and complications such as sinus membrane perforation, infection, failure to break the bone window due to the presence of antral septa, graft loss and oroantral fistula formation can be reduced.

Dental Rehabilitation of Patients with Extreme Resorption of the Alveolar Process of the Upper Jaw with the Use of Zygomatic Implantation

The innovative method of zygomatic implantation is a rational method of dental rehabilitation for extreme resorption of the alveolar ridge. However, like any method, it is associated with certain disadvantages. These include: difficult surgical access requiring significant experience, risk of orbital injury, prolonged speech dysfunction, postoperative sinusitis, oroantral fistula, periorbital and conjunctival hematoma. The aim of the study was to evaluate the long–term results of maxillofacial and dental rehabilitation using zygomatic implantation. A comparative analysis of the obtained data revealed a significantly lower frequency of early postoperative complications with the use of zygomatic implantation 3 (2,6 % p = 0,112) compared with classical implantation 8 (11,5 % p < 0,002). There were no cases of zygomatic implants rejection, unlike traditional implantation, 8 (11,5 % p < 0,002). Conclusion. Rehabilitation of patients with extreme alveolar process resorption using zygomatic implants has shown high efficiency, with a significantly lower frequency of local complications and fewer lost implants compared with traditional implantation.

Closure of oroantral fistula using platelet rich fibrin with endoscopic middle meatal antrostomy

BackgroundOroantral fistula (OAF) involves pathological, epithelialized, and unnatural communication between the maxillary sinus and oral cavity. Recently, functional endoscopic sinus surgery has provided minimally invasive treatment options with fewer postoperative complications. The aim of the study was to evaluate the one-stage endoscopic middle meatal antrostomy (EMMA) technique with the application of a platelet-rich fibrin membrane (PRF) for OAF closure and maxillary sinusitis relief.Patients and methodsPatients who suffered from OAF with odontogenic sinusitis were included in this study. Complete excision of the epithelial tract and any necrotic tissue was performed with proper curettage. Then, EMMA was performed with simultaneous closure of the OAF by the application of PRF membranes that were fixed by sutures and covered with an acrylic splint. Patients were clinically evaluated for OAF closure, pain level, and symptom relief. Additionally, the size of the bone defect was measured with the aid of computed tomography (CT) preoperatively and after 24 weeks postoperatively.ResultsThis study included nine eligible patients with a mean age of 38 years. The data were collected, tabulated, and statistically analyzed. Soft tissue healing and bone formation occurred in all patients who achieved maxillary sinusitis relief without any complications. Additionally, pain was significantly lower on the 7th postoperative day than on the 1st postoperative day, according to the statistical analysis of the results (p < .001).ConclusionsOne-stage EMMA with the application of PRF membranes and acrylic splint represents a reliable alternative technique for OAF closure and maxillary sinusitis relief that is associated with a lower incidence of complications and minimal postoperative pain.Trial registrationThe trial was registered on 28/02/2024, at clinicaltrials.gov (ID: NCT06281873).

Sinus irrigation as an adjunctive therapy for odontogenic maxillary sinusitis — an in-depth analysis

BackgroundOdontogenic maxillary sinusitis (OMS) is widely acknowledged in both the dentistry and otolaryngology fields. Recently, iatrogenic odontogenic maxillary sinusitis cases can be encountered frequently. The purpose of this study was to evaluate the effect of intraoral sinus irrigation using the small lateral window approach in patients with odontogenic maxillary sinusitis by comparing pre- and postoperative volumetric measurement of CBCT and symptoms.We surveyed 21 patients who visited the Oral and Maxillofacial Surgery Department at PNUDH from 2016 to 2022. All the patients’ information was extracted from an electronic database. The patients with a follow-up period of 2 months or more were included. The three-dimensional volumetric measurement was performed using the ImageJ program (National Institute of Health, University of Wisconsin).ResultsAmong 21 patients, 16 (76.1%) were male, and 5 (23%) were female. The most common type of surgery was general anesthesia (16 cases) in which oroantral fistula was present in 7 cases. In the causes of maxillary sinusitis, there were seven implant-related patients, five patients of tooth extraction, seven patients of bone grafting, and two patients in other groups. Radiographic opacity decreased by 40.15% after sinus irrigation especially in bone graft and tooth extraction cases. Clinically, symptoms improved in 17 patients (80.9%).ConclusionBy this study, it can be concluded that maxillary sinus irrigation using the small lateral window approach is a clinically and radiologically effective treatment method for odontogenic maxillary sinusitis.

A Novel Approach to Treat Dental Implant-related Maxillary Sinusitis via Intentional Oroantral Fistula: Case Series

The recent increase in dental implant placement and advances in maxillary sinus bone grafting have improved the oral environment and greatly benefited patients, but there has also been an increase in dental implant-related maxillary sinusitis. Implant-related maxillary sinusitis is a form of odontogenic maxillary sinusitis, which usually presents as a chronic form of maxillary sinusitis. While acute (4 weeks or less) maxillary sinusitis is treated with removal of the associated implant, decontamination of the contaminated bone graft materials, and antibiotics. However, implant-related maxillary sinusitis is most often diagnosed as a chronic maxillary sinusitis condition that has been present for more than 12 weeks and should be treated similarly to chronic maxillary sinusitis. Treatment for chronic implant-related maxillary sinusitis is accompanied by endoscopic sinus surgery (ESS) to open the obstructed maxillary ostium. ESS is usually performed by referral to an ENT specialist and can be a burdensome treatment for patients due to the discomfort of surgery and the risk of orbital and cranial complications.In this case series, we aim to help dentists treating chronic implant-related maxillary sinusitis by reporting the complete cure of implant-related maxillary sinusitis without performing ESS by creating an intentional oroantral fistula after removing the causative implant. We also report important pathologies that should be differentiated from typical implant-related maxillary sinusitis.

The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis.

The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: "oro antral communication (OAC)" OR "oro antral fistula (OAF)" OR "antro-oral communication" OR "communication between maxillary sinus and oral cavity" OR "oro-sinusal communication" OR "oro-sinusal fistula" OR "sinus communication" OR "sinus fistula" OR "antral communication" AND "treatment" OR "management" OR "surgical treatment" OR "surgical interventions". This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse.

Evaluation of Clinical Success of the 3D-Printed Custom-Made Subperiosteal Implants.

The authors aim to share their experiences in subperiosteal implant applications in atrophic jaws, which have been practiced in their clinic for about 2 years, and evaluate the complications and clinical success of the implants. Clinical and radiologic data of 32 patients who underwent subperiosteal implantation for advanced alveolar bone loss were evaluated, but 1 patient was excluded as they smoked. Of the 31 patients included in the study, 27 were operated with the diagnosis of total tooth loss, 3 for maxillectomy and 1 for partial tooth loss. A total of 60 subperiosteal implants were placed in them. The mean follow-up period was 15 months. During the operation, implant-bone adaptation problems were encountered in 11 patients, implant skeletal fracture in 1 patient, and loss of primary stabilization during mini-screw fixation in 2. Although there were no complications in the early postoperative period, biological and prosthetic complications occurred in the late postoperative period. Soft tissue retraction at various levels in 12 patients (only keratinized tissue retraction in 6 and mucosal retraction exceeding keratinized tissue in 6), soft tissue infection in 5 and oroantral fistula development in 1, mini-screw loosening in 3 were the biological complications that occurred. Various complications may occur during or after the application of custom-made subperiosteal implants. However, these are manageable and can be reapplied in case of a possible implant loss, making it an important alternative, especially in atrophic jaws where endosseous dental implants cannot be applied.

A pedicled buccal periosteal flap for the closure of oro-antral fistula

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

Surgical Treatment of the Oroantral Fistula in a Patient with Myasthenia Gravis: Clinical Considerations and Anesthetical Management

Surgical Treatment of the Oroantral Fistula in a Patient with Myasthenia Gravis: Clinical Considerations and Anesthetical Management

Evaluation Of The Frequency, Localization And Relationship Of Maxillary Sinus Pathologies With Dental Pathologies By Cone Beam Computed Tomography (CBCT)

Background: The proximity of the root tips of the maxillary posterior teeth to the maxillary sinus causes odontogenic infection to become a potential source of maxillary sinusitis. This study aims to evaluate the relationship between dental pathologies and maxillary sinus abnormalities using cone beam computed tomography (CBCT). Material and Method: In this study, 300 patients who applied to our clinic for any reason 600 maxillary sinus cone beam computed tomography images of the patient were analyzed retrospectively. Maxillary sinus diseases and dental pathologies categoized among themselves. Results: The age of all patients ranged between 18 and 77 years, with a mean age of 41.38 (±14.39) years. No pathology was detected in 359 (59.8%) of the maxillary sinuses examined which were considered healthy sinuses. The most common pathology in 241 (40.2%) of the maxillary sinuses in the imaging area was mucosal thickening (MT). A statistically significant relationship was detected between teeth with periapical lesions (PL) and MT (p&amp;lt;0.05). No statistically significant relationship was found between restorative applications, oro-antral fistula (OAF), periodontal bone loss (PBL), and maxillary sinusitis (MS) (p&amp;lt;0.05). Conclusion: Odontogenic infections and inflammatory events are the causes of maxillary sinus pathologies and may play a role in their formation. CBCT, maxillary posterior teeth and maxillary sinüs in demonstrating the relationship between and in the diagnosis of odontogenous sinus pathlogies is quite useful.

Diagnosis dan Tatalaksana Rinolit Pada Pasien Lansia

Introduction: Rinolits are uncommon foreign bodies in the nose, which serve as a nidus for calcium salt deposition. Foreign bodies can be endogenous or exogenous in origin and can be asymptomatic for years before being discovered incidentally. If left untreated, stones can cause unilateral nasal obstruction, rhinorrhea, epistaxis, or in rare cases, progressive damage leading to septal/palatal perforation or oro-antral fistula. Surgical stone removal is an effective intervention with rare reports of complications. Case Report: A case of rinolit in a 72-year-old woman with complaints of left nasal congestion since 2 months ago with thick, smelly snot in the past 2 weeks is reported. History of foreign entry was denied. On examination of the sinistra nasal cavity, it was found that the nasal cavity was narrow, the inferior concha was edematous, there was a yellowish mass between the inferior concha and the septum, the media concha was difficult to assess, septal deviation was present, sekret was present, mucoid. The management given was extraction using forceps under local anesthesia. Conclusion: Rinolit is an uncommon clinical etiology which if undiagnosed can lead to complications; thus it is important to consider for any unilateral nasal symptoms of unclear origin.&#x0D; &#x0D; &#x0D;

Risk factors, Consequences and Treatment Alternatives of Schneiderian Membrane Perforation: Case Report and Review of the Literature

Maxillary sinuses are the greatest sinus cavities in the human cranium and they are the closest to the oral cavity. Thus, perforation of the Schneiderian membrane is a common complication that may be encountered during various oral surgery procedures in the molar and premolar regions of the maxilla such as teeth extractions, implant placement or sinus augmentation procedures. Membrane perforations lead to oroantral communications, which may later turn into oroantral fistulas. Moreover, these perforations may cause infections, loss of graft or implant if encountered during sinus augmentation procedures. The purpose of this review was to determine the risk factors associated with this complication and present the various treatment alternatives used to manage this type of complication. In the literature, the selected surgical technique, the thickness of the sinus membrane, the quality and quantity of the residual alveolar bone, the anatomy of the area and patients’ habits such as smoking were reported as points to be considered. A case of Schneiderian membrane perforation during implant placement and successful management of the complication was also presented.