Oroantral Fistula Research Articles

CLASSIFICATION OF MAXILLOFACIAL DEFECTS: A REVIEW ARTICLE

Defects in the maxillary jaw can be congenital, developmental, acquired, traumatic or surgical involving the oral cavity and related anatomic structure.Absence or loss of some or all of the soft palate and / or hard palate results in insufficient structure or altered function of the remaining tissues. Defects can cause disruption of articulation and airflow during speech production and also nasal reflux during deglutition. Patients after surgical resection have altered anatomy due to scaring, tissue contracture, lack of bony support and tissue edema. These patients have problem of regurgitation of water and food through nose and difficulty in speech. These changes require the fabrication of prosthesis and also sometimes repeated prosthesis adjustments to confirm to the soft tissue changes. To prevent this and to help the patient in deglutition and speech defects must be restored with prosthesis. In such situation an obturator is designed to close the opening between the residual hard and / or soft palate and the pharynx. The prosthesis provided for these patients are called as obturators. An obturator is a prosthesis which is fabricated for the patients with the palatal defects in the form of cleft lip and palate, oroantral fistula or surgical resection after removable of pathology like tumor or cancer. This review article will highlight on the Prosthetic Rehabilitation of the maxillary defects and the types of obturators.

The role of radiology in risk assessment and management of oroantral fistula and displaced roots

AbstractThere is a weak evidence base on which to define the most appropriate radiographic technique to evaluate dental tissues that may impact on the maxillary sinus, including the risk assessment for oroantral communications, identification and removal of displaced roots, timing and optimal management of oroantral fistula, in the presence of odontogenic sinusitis. There is no demonstrable benefit from the routine use of CBCT in exodontia. However, cross‐sectional imaging is strongly recommended over 2‐dimensional radiographic techniques when identifying displaced roots of teeth, and during surgical management of oroantral fistulae, particularly when considering the incidence of extra‐maxillary disease in odontogenic sinusitis. In this narrative review, using the limited evidence available, and relying on clinical experience, we adopt a risk–benefit analysis for the optimal use of various radiographic imaging modalities from pre‐operative assessment to management of complications, focusing on patient outcomes.

Foreign Bodies in Sinonasal Tissues: A Potential Pitfall yet a Hint to Oroantral Fistulas.

Foreign bodies in the maxillary sinus are infrequent findings with various organic and inorganic materials have been reported. Most are iatrogenic due to abnormal communications between the oral cavity and the sinus cavity, predominantly secondary to dental and oral procedures. Oroantral fistulas might be asymptomatic incidental findings or may present with sinusitis-related symptoms. Even though oroantral fistulas are frequently encountered iatrogenic complications, most studies focused on radiologic findings and surgical closure procedures. A few cases reported the histopathologic findings of foreign body-related antral sinusitis. Our aim is to report three cases of chronic maxillary sinusitis induced by various foreign bodies of oral and dental origin associated with oroantral fistulas. Our focus is to highlight the different histopathologic patterns, potential pitfalls and helpful clues of foreign body-induced maxillary sinusitis. Altered foreign bodies in procured sinus specimens might be missed, misinterpreted or ignored by pathologists. Obvious vegetable food remnants were detected, but subtle vegetable residuals showed pulse granuloma, rings and sheet-like patterns embedded in the granulation tissue and fibrous stroma. Some materials mimicked fungal hyphae while others were ignored as nonspecific debris. Periodic acid Schiff stain and polarizing light helped delineate their nature. Other helpful hints included the presence of oral-type squamous epithelium, crystals, hemosiderin pigments, dental materials such as alvogyl, and microorganisms of oral origin for example Actinomyces. Our series emphasizes the importance of correct recognition of foreign bodies of oral and dental origin in paranasal specimens to guide clinicians to the possibility of oroantral fistula-associated odontogenic sinusitis versus conventional rhinosinusitis.

Intraoperative complications and early implant failure after transcrestal sinus floor elevation with residual bone height ≤5 mm: A retrospective multicenter study.

ObjectiveClinical indications for maxillary sinus floor elevation with transcrestal techniques have increased in recent years even in sites with minimal residual bone height (RBH). Nevertheless, limited information is currently available on incidence of intraoperative complications and early implant failure in these cases.Material and MethodsThis retrospective multicenter study was performed on anonymized clinical and radiographic records of patients who underwent transcrestal sinus floor elevation in seven clinical centers. Influence of different factors related to patient, and sinus anatomy and surgical technique on the incidence of intraoperative complications and early implant failure rate after transcrestal sinus lift were investigated.ResultsA total of 430 patients treated with transcrestal sinus floor elevation for single‐implant insertion in sites with RBH ≤5 mm were included in the final analysis. After 1 year of loading, 418 implants of 430 were satisfactorily in function. Early implant failure was recorded in 12 cases (2.8%); results were significantly associated with the presence of large sinus cavities and with the occurrence of membrane perforation.The following adverse events were recorded: membrane perforation (7.2%), acute sinusitis (0.9%), implant displacement into the sinus cavity (0.7%), oro‐antral fistula (0.2%), and benign paroxysmal positional vertigo (0.5% of osteotome cases). A strong direct correlation between sinus membrane perforation and bucco‐palatal sinus width (p = .000) was demonstrated.ConclusionsEarly implant failure after transcrestal sinus elevation showed significant direct correlation with bucco‐palatal maxillary sinus width and the presence of membrane perforation. Sinus membrane perforation was strongly associated with bucco‐palatal sinus width (extremely low perforation rate in narrow and much higher incidence in wide sinuses).

Infected Dentigerous Cyst of Maxillary Sinus Mimicking Intraoral Abscess in a Pediatric Patient: Management of Misdiagnosis and Inaccurate Treatment

The article presents the case of a 12-year-old male patient who was suffering from exacerbated (infected) dentigerous cyst of maxillary sinus, associated with impacted canine whose symptoms were deceptively similar to intraoral abscess. The first-aid treatment performed by general dental practitioner consisted of intraoral incision and resulted in oroantral fistula formation. Eventually, the patient's ailments were not resolved, and we had to deal with serious local complications and difficulties. The treatment was performed under general anesthesia in one-day surgery system and included enucleation of the lesion, excision, and closure of oroantral fistula. Dislocated canine was not removed, and its subsequent eruption was observed.

Cloud of cotton inside the maxillary sinus: A unique case report worth sharing

The maxillary sinus is one of the most important structures present in the vicinity of the oral cavity. Unknowingly, it often gets involved when the environment of dentoalveolar structures of the maxillary unit jeopardize. There are lots of reasons such as trauma, forceful extraction which may change the internal environment of the maxillary sinus, and the balance of its microbial flora. Among them, oroantral communication and oroantral fistula cause chronic sinusitis inevitably. However, this case is unique by virtue due to the formation of chronic sinusitis by the intrusion of a foreign body by the patient himself and followed by the formation of an oroantral fistula after the extraction of an offending tooth.

THE EFFECTIVENESS OF THE TWO-LAYERED CLOSURE OF PERSISTENT OROANTRAL FISTULA USING BUCCAL FAT PAD AND BUCCAL ADVANCEMENT FLAP.

Background: A prospective clinical study was conducted to assess the effectiveness of the two -layered closure of recurrent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap. Materials and methods: Twenty patients with persistent OAFs larger than 5 mm were treated with two layered closure using Buccal Fat Pad and Buccal Advancement Flap.They were followed clinically and radiographically for 5 years after surgery to monitor the durability and effectiveness of the two layered closure of the OAF. Result: The procedure was successful in all patients. The healing process was satisfactory,with no breakdown or liquefaction necrosis postoperatively.No complications were observed during the follow-up period. Conclusion: The results of this study support the view that the use of the double-layered closure using BFP with buccal advancement flap is a durable,convenient,and effective method for the treatment of a persistent large OAF.

Multilayered Closure of Oronasal and Oroantral Fistula Using Intranasal and Intraoral Flaps.

Multilayered Closure of Oronasal and Oroantral Fistula Using Intranasal and Intraoral Flaps.

Treatment of oroantral communication with Platelet-Rich Fibrin: A systematic review

BackgroundOroantral communication (OAC) is the opening between the maxillary sinus and the oral cavity, which constitutes a gate for the mucosal infection in the maxillary sinus. On the other hand, an OAF develops when the OAC does not close spontaneously, remains manifest and is epithelialized. Several methods have been proposed to solve these situations, however, they are associated with increased postoperative morbidity and/or higher associated costs and require some experience of the surgeon to perform them. To overcome these disadvantages, the use of Platelet-Rich Fibrin (PRF) is proposed. The present study aims to perform a systematic review of the literature, collecting cases in which PRF was used in the treatment of OACs/OAFs. Materials and methodsAn electronic search of the MEDLINE database (via PubMed) and Web of Science was performed using the following MeSH terms (Medical Subjects Headings): (oroantral communication OR oroantral fistula OR buccosinusal communication) AND (platelet-rich fibrin OR prf OR fibrin mesh). The criteria used were those described by the PRISMA® Statement. The search was not time-restricted and was updated to April 2021. ResultsAfter searching, 11 articles were included that met the established criteria. In these, PRF was used alone or in combination with bi- or trilaminar techniques achieving complete resolution in 100% of cases (n = 116). ConclusionsWith the limitations of this study, it can be established that PRF can be used alone for the treatment of OACs/OAFs up to 5 mm and, in larger defects, it is advisable to combine it with bi- or trilaminar techniques. PRF is an effective therapeutic option, with minimal associated postoperative morbidity compared to other techniques and allows the position of the mucogingival junction to be preserved. Its combination with bone grafting improves the starting point before the replacement of the missing tooth with a dental implant.

Changes in the microbiome during oral wound healing

• Given that microbes in the oral cavity can impact health and disease, manipulating the oral microbiome may be a viable option in health. • Results demonstrate that identifying candidate beneficial microbes that promote oronasal fistula healing is critical to developing new therapies that promote healing. • Overuse of antibiotics during oronasal fistula repair surgery has significant long -term effects in pediatric populations. • Use of novel methodologies for delivering probiotics to oral wounds using hydrogel and porous scaffold technologies are clearly warranted. • Improving oral wound healing may limit the devastating impact of oronasal fistulas on the quality of life of children. The microbiome is a numerically vast and taxonomically diverse microbial community that includes bacteria, fungi and viruses. The microbiome inhabits all exposed surfaces of the body and exist in a symbiosis with the host in health individuals. The microbiome can affect normal physiology of a number of host organs and systems, while a disturbance in the microbiota community structure, or failure of host responsive mechanisms to the microbiome have been implicated in a variety of disease etiologies. One of the least well-funded areas of microbiota research in relation to health and disease is the community of microbes that inhabits the oral cavity. Here, we outline the importance of the influence of the oral microbiome on healthy oral tissue homeostasis, the therapeutic options of treatment with live bacteria for diseased states within the oral cavity, and how the oral microbiome may influence healing of oral wounds resulting from oroantral and oronasal fistulas. In addition, we discuss the oral microbiome in relation to its influence on bodily organs distant from the alimentary canal, and on systemic health and disease.

Management of oroantral fistula with displacement of the root into sinus using buccal fat pad: a case report

Oroantral fistula (OAF) refers to a permanent connection between oral cavity and maxillary sinus. The extraction of maxillary posterior teeth is the most common reason of OAF. Multiple techniques are available to repair this defect. The most used procedures involving local flaps include buccal flap, buccal fat pad (BFP), and palatal rotating flap. We here present an original technique of management of oroantral fistula with displacement of the root into sinus using BFP.

Closure of Oroantral Communication with Gelfoam and Collagen Membrane after Periapical Cyst EnucleationA Case Report

Periapical cyst is the most common inflammatory cyst that occurs in jaw bones. Epithelial cell rests of Malassez in periodontal ligaments are the main cause for the periapical cysts to be formed. Periapical cyst occurs commonly in infected and necrotic periapical area, with male sex predilection and occurs especially in the 3rd to 6th decades of life. Non vital tooth left untreated for long time predisposes to periapical cyst formation. Oroantral Communication (OAC) is one of the most routinely encountered complications during surgical procedure by oral and maxillofacial surgeons when attempting to remove a cyst from maxilla. Oroantral communication is the abnormal, pathologic, unnatural open connection between the oral cavity and maxillary sinus. If such a communication remains open it can cause ingress of microorganisms from the oral cavity into the antrum resulting in maxillary sinusitis, and develops into an Oroantral Fistula (OAF). Hereby, authors presented a case report of a 32-year-old female patient with the complaint of pain and swelling in relation to the left upper back tooth region. The gelfoam and collagen membrane used to close an oroantral communication, which was developed after periapical cyst enucleation.

Effect of Surgical Repair of Chronic Oroantral Fistula Using PRF with Tailored 3D Printed Mesh

Effect of Surgical Repair of Chronic Oroantral Fistula Using PRF with Tailored 3D Printed Mesh

Bichat's fat pad for the closure of oroantral fistula

Bichat's fat pad for the closure of oroantral fistula

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Open surgical approach to management of rhino-orbito-cerebral mucormycosis

<p class="abstract"><strong>Background: </strong>Since December 2019, when novel corona virus (COVID 19) was reported, it has spread widely to cause a pandemic. Rhino-orbito-cerebral Mucormycosis (ROCM), an opportunistic fungal infection caused by the order Mucorales and class Zygomycetes has led to an epidemic in our country.</p><p class="abstract"><strong>Methods: </strong>This prospective cross sectional study was conducted at a 1200 bed tertiary care teaching hospital in Mysore. All patients of ROCM who presented to us for treatment were selected for the study after informed consent. Only those patients who were operated via open approach were included.</p><p class="abstract"><strong>Results:</strong> Median age of the patients was 50 years (SD±10). 49 were male patients (67.1%). Diabetes mellitus was the most common underlying co-morbidity seen in 71 patients (97.3%). Facial pain (100%) and facial swelling (90.4%) were the most common presenting complaint. KOH positivity from nasal swab for Mucormycosis was positive in only 37 patients (50.7%). Traditional inaccessible areas to endoscope like the premaxilla, lateral orbit cavity, infra temporal fossa and hard palate were tackled by the open surgical approach route. Advantages of open surgical approach being the access to areas which are traditionally difficult to approach via the endoscope, aggressive debridement is possible which might be challenging endoscopically. Complications like wound dehiscence, oro-antral fistula, osteomyelitis and abscess were noted in our study.</p><p class="abstract"><strong>Conclusions: </strong>Open surgical approach offers a very viable, affordable and a very effective means for aggressive surgical debridement of infection and reduce mortality associated with ROCM.</p><p> </p>

Post-traumatic Actinomycotic Oro-antral Fistula Closure with Three-dimensional Stereolithographic Modeling and Patient-Specific Titanium Implant.

We report an interesting case of a post-traumatic actinomycotic oro-antral fistula of the left posterior maxilla, that was not salvageable via local flaps due to the size of the defect and was managed with the patient-specific titanium implant, fabricated by three-dimensional stereolithographic model planning followed by primary closure.

Subperiosteal inferior maxillectomy in mucormycosis patients: case series.

Mucormycosis is a rapidly progressive and fulminant fungal infection mainly affecting the nose and paranasal sinuses and often requiring aggressive surgical debridement, which commonly includes inferior maxillectomy. Conventional inferior maxillectomy involves removal of the bony hard palate and its mucoperiosteum. This can lead to formation of an oroantral fistula and thereby increase the morbidity in these patients leading to prolonged rehabilitation. Subperiosteal inferior maxillectomy involves sparing of the uninvolved mucoperiosteum of the hard palate. This flap is used for closure of the oroantral fistula, which preserves the functional capabilities of the patient, such as speech, mastication and deglutination. This case series describes the experience of using the technique of mucosa-preserving subperiosteal inferior maxillectomy in five patients with mucormycosis. With the technique used in this study, complete oronasal separation was achieved in all six patients. The overall surgery time was also decreased when compared with free tissue transfer. Patients also did not have to bear the weight of prosthesis. Mucoperiosteal palatal flap-preserving subperiosteal inferior maxillectomy is an excellent approach for all patients with mucormycosis and healthy palatal mucosa.

1211 An Ameloblastoma Or Intra-Oral Basal Cell Carcinoma? A Clinical Case Report

Abstract A basal cell ameloblastoma is an uncommon benign neoplasm and has a similar histological appearance to basal cell carcinoma of the skin. This clinical case report will discuss an ameloblastoma originating in the maxilla and of the baseloid variant. The objective of report is to highlight the possibility of misdiagnosis from this challenging case. A 34-year-old male was referred to the maxillofacial department with recurrent nasal regurgitation following dental extraction from the left maxilla 1 year previous. Clinically there was an oro-antral fistula visible and initial CT showed cystic lesion in the left maxilla likely to represent an odontogenic cyst. The patient underwent extraction and enucleation, where the diagnosis of the amelobalstoma was established with need of resection. Partial maxillectomy and primary closure with buccal fadpad was performed in the second stage and histological results showed a 6mm completely excised basal cell carcinoma within the oral mucosa and no bony invasion. Due to this extremely unusual results, secondary histological review was requested, and conclusion was a fully excised basal cell ameloblastoma. Following the procedure and subsequent reviews, the patient has no evidence of oro-antral fistula or recurrence of this rare type of neoplasm. A basal cell ameloblastoma variant is a rare lesion and due to its’ similar histological appearance to a basal cell carcinoma, can lead to a misdiagnosis. The aim of the report is to show the unusual presentation and findings along the way to correct diagnosis in this case.

1662 Closure of Oro-Antral Fistulae in Conjunction with Functional Endoscopic Sinus Surgery: A Retrospective Analysis + Systematic Review

Abstract Aim The aim of this study was to evaluate the surgical closure of OAFs created following dental extractions in conjunction with FESS in adult patients within a hospital in South Wales, UK, during a 5-year period, from 1st January 2014 to 31st December 2018, with a systematic review of the literature to investigate success rates. Method A manual search in the hospital’s theatre system for surgery between 2014 and 2018 containing codes for FESS, OAC or OAF was completed. These were screened for joint cases, and the patient’s hospital numbers entered into a Microsoft Excel spreadsheet. A retrospective analysis of their clinical records was performed. Success was measured as total closure and relief of sinusitis after 1 month. The PRISMA format was used to complete the systematic review. Results 13 patients (mean age 51 ± 12.44, 7:6 male to female) met the inclusion criteria. The most common cause was extraction of the maxillary first molar. A 100% success rate was achieved, with no patients requiring revision surgery. The systematic review highlighted an average success rate of 98.7%. A protocol for the management of OACs was designed in both English and Welsh and distributed to Primary Care Dentists within South Wales. Conclusions OAF closure with FESS can be considered as a highly effective approach, leaving patients symptom free. It is important that protocols are in place for dentists suspecting an OAC in order to expedite patient management.