Oroantral Fistula Research Articles

English

BACKGROUND The maxillofacial region has several congenital and acquired defects. Because of its abundant blood supply and proximity to different intraoral abnormalities, the buccal fat pad flap (BFP) is a simple and reliable flap that can be used to repair a variety of these abnormalities. BFP has remarkable qualities as a scaffold and autogenous dressing in the healing of intraoral defects after excision of oral cavity intraoral lesions. Filling and allowing slippage of fascial spaces between muscles of facial expression, advancement of intermuscular motion, isolating mastication muscles from one another, counteracting negative pressure during suction in the newborn, protection and cushioning of neurovascular bundles from injuries are among the functions of BFP. It also has a dense venous network that facilitates exoendocranial blood flow via the pterygoid plexus. For many years, the BFP was considered a surgical annoyance due to its incidental encounter during various surgeries in the pterygomaxillary space or following injuries to the craniofacial region. However, various clinical applications of BFP have been introduced in recent years. We looked at BFP and its anatomical foundation, surgical procedures, and clinical applications in this review article. The surgical method is easy and effective in a wide range of clinical situations, including oroantral fistula closure, congenital defect rectification, Osteoradionecrosis treatment, and reconstruction of tumor or cyst defect. Thus BFP is a dependable flap that may be used in a variety of therapeutic conditions. KEY WORDS Buccal Fat Pad Flap; Oral Mucosa; Reconstruction; Defect.

Severe Complications Following Maxillary Sinus Augmentation Using Poly L-lactide-co-ε-caprolactone-Coated Bovine Bone: A Retrospective Study.

To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-ε-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations.

Sagittal Maxillary Fracture: Diagnosis and Management.

Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.

Time to be nosy: Evaluating the impact of environmental and sociocultural changes on maxillary sinusitis in the Middle Nile Valley (Neolithic to Medieval periods)

ObjectiveTo investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions. Materials481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE–CE 1500). MethodsBony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria. ResultsThere were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease. ConclusionsFactors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis. SignificancePrior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today. LimitationsPoor preservation of skeletons and a lack of archaeological settlement data for some sites. Future researchInvestigation of a greater range of populations from different environments/climates.

Aspergillosis of the Maxillary Sinus Associated With Dental Implant.

Aspergillosis is a fungal disease caused by the fungus Aspergillus; this disease frequently involves the lungs and occasionally the maxillary sinus. Aspergillosis in the maxillary sinus usually has the characteristics of a noninvasive form. It has been suggested that spores of aspergillus can be inhaled into the maxillary sinus via the osteomeatal complex or via an oroantral fistula after dental procedures, such as an extraction. However, maxillary aspergillosis related to implant installation has rarely been reported. This report regards unusual cases of maxillary aspergillosis associated with dental implant therapies in healthy patients. The cases were successfully treated with the surgical removal of the infected or necrotic tissues.

Oro-Antral Fistulas and their Management: Our Experience.

Oroantral fistula (OAF) is an epithelized, pathological communication between the maxillary antrum and oral cavity. The most common etiological factor is molar or premolar tooth extraction. The bone between maxillary sinus floor and posterior teeth is thin and occasionally the root apices of the posterior teeth reach the maxillary sinus, predisposing them to the formation of OAF. Other causes are bacterial or fungal infections, osteomyelitis, granulomatous diseases, Paget's disease, malignancy, maxillofacial trauma and iatrogenic. Small OAFs heal spontaneously but larger fistulas, persisting more than three weeks need to be closed. In repairing the persistent OAF, the maxillary sinus must be addressed. Maxillary sinusitis may lead to the failure of closure of the OAF. The basic modus operandi is clearance of disease from the sinus and covering the defect with a suitable graft. Various local and distant flaps are used to repair the OAF. We report three cases of OAF, managed by three different techniques. We also suggest a combined approach for large OAFs, repaired in 3 layers using septal cartilage, fat, and a buccal muco-periosteal advancement flap.

Intrusion of maxillary molar roots into the maxillary sinus in a sample of the Egyptian population using cone beam computed tomography

BackgroundThe proximity of the maxillary sinus floor to the maxillary molar roots increases the probability of oroantral communication on conducting any surgical or endodontic procedure in the involved area. The aim of this study is to evaluate the relationship between each maxillary molar root and maxillary sinus floor using cone beam computed tomography. Predicting the probability of protrusion of each root into the sinus will consequently predict the probability of occurrence of the oroantral fistula in a sample of the Egyptian population.ResultsThe total number of roots located outside the sinus was 121 (35.3%), while those contacting the sinus floor were 80 (23.3%) and those intruded the sinus were 141 (41.2%). The percentage of root intrusion into the sinus in males (56.9%) was significantly (p = 0.01) higher than females (42.9%). The probability of root intrusion in the left molars (54.2%) was non-significantly (p = 0.067) higher than that of the right side (44.3%). As for the type of tooth, the second molar showed the highest probability of root intrusion into the sinus (55.3%) followed by the third molars (52.6%) then the first molars (40.9). According to the type of root, the mesiobuccal root showed the highest probability of intrusion into the sinus (50.9%) followed by the palatal root (49.1%) then the distobuccal root (47.4%). However, the difference in both type of tooth and type of root was statistically non-significant (p = 0.051 and 0.869 respectively). As for the individual root with the highest probability of intrusion, the mesio-buccal root of the right third molar is the most frequent root to intrude the sinus (71.4%) and the mesio-buccal root of the right first molar is the least frequent (22.7%).ConclusionsIn a sample of the Egyptian population, males exhibit higher probability of root protrusion into the sinus than females. The side and type of tooth are of higher impact on the probability of its intrusion into the sinus compared to the type of root. Left second molars are at a higher risk of oroantral communications on surgical or endodontic procedures compared to other molars due to its highest probability of intrusion into the sinus.

The use of a pedicled buccal fat pad for reconstruction of posterior mandibular defects

BackgroundThe pedicled buccal fat pad has been used for a long time to reconstruct oral defects due to its ease of flap formation and few complications. Many cases related to reconstruction of defects in the maxilla, such as closing the oroantral fistula, have been reported, but cases related to the reconstruction of defects in the mandible are limited. Under adequate anterior traction, pedicled buccal fat pad can be a reliable and effective method for reconstruction of surgical defects in the posterior mandible.Case presentationThis study describes two cases of reconstruction of surgical oral defects in the posterior mandible, all of which were covered by a pedicled buccal fat pad. The size of the flap was sufficient to perfectly close the defect without any tension. Photographic and radiologic imaging showed successful closure of the defects and no problems were noted in the treated area.ConclusionIn conclusion, the pedicled buccal fat pad graft is a convenient and reliable method for the reconstruction of surgical defects on the posterior mandible.

Nasolabial island flap for management of post osteo-odonto-keratoprosthesis oroantral fistula

Osteo-odonto-keratoprosthesis (OOKP) is a procedure that is beneficial to patients with end-stage ocular disease, which is not amenable to corneal transplantation. It involves the harvest of tooth lamina and implantation of lamina cortex into the eye. The oroantral fistula (OAF) is one of the most disastrous complications of this procedure. The complication of an OAF during the harvest of a molar for an OOKP procedure can be prevented by applying a sound surgical technique. However, in case an OAF develops, it can be managed by a variety of options depending on the dimensions of the defect. In this report, we present the use of a nasolabial flap along with an upper sulcus flap for coverage of an OAF after undergoing an OOKP procedure. Measures to avoid this disastrous complication have also been discussed.

Role of Endoscopic Sinus Surgery and Dental Treatment in the Management of Odontogenic Sinusitis Due to Endodontic Disease and Oroantral Fistula.

Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice; however, there are no guidelines regarding its management. This study aims to analyse the results of endoscopic sinus surgery versus dental treatment in ODS. Additionally, we aim to demonstrate the benefit of associating endoscopic sinus surgery (ESS) to surgical closure of chronic oroantral fistulas (OAF) by comparing mean time to healing in patients who opted or not for concurrent ESS. Methods: Records of patients with ODS were reviewed. Group one consisted of patients with ODS caused by periapical pathology undergoing either endoscopic sinus surgery (ESS) or dental treatment. Resolution of ODS was considered treatment success and was compared between the two treatment strategies. Group two included patients with ODS and associated chronic oroantral communication. Time to healing was compared between patients undergoing OAF closure alone versus patients receiving associated ESS, using the Log-Rank test to correlate Kaplan–Meier curves. Results: 25 patients from a total of 45 in group one underwent dental treatment alone, and 20 opted for exclusive ESS treatment. The failure rate was 40% for patients treated with ESS compared to 4% (one patient) for dental treatment. ODS resolved in all patients in the second group, but the mean time to healing was half (10 days) when ESS was complementary to OAF closure. Conclusion: The present study represents the first estimator of the role ESS plays in OAF treatment. Nonetheless, it provides proof of the importance of first addressing dental problems in odontogenic sinusitis.

Implant-supported restoration of a missing maxillary first molar with oro-antral fistula

Implant-supported restoration of a missing maxillary first molar with oro-antral fistula

How does pedicled buccal fat pad flap (PBFPF) compare with buccal flap (BF) for treating patients with oro-antral communication and fistulae due to dental procedures?

How does pedicled buccal fat pad flap (PBFPF) compare with buccal flap (BF) for treating patients with oro-antral communication and fistulae due to dental procedures?

A case of grafted repair of an oro-antral fistula following non-surgical periodontal therapy

Oro-antral communication is a well-recognized complication of dental extractions in the maxilla, but is rarely reported to occur from periodontal causes. This article describes the formation of an oro-antral communication following non-surgical periodontal therapy, and its subsequent management. CPD/Clinical Relevance: This article presents a previously unreported formation of an oro-antral communication following non-surgical periodontal therapy, in a patient with localized periodontitis and presence of a root cementum defect. It is of relevance to all dentists managing periodontal disease.

Second wave of COVID-19 pandemic and the surge of mucormycosis: Lessons learnt and future preparedness: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Second wave of COVID-19 pandemic and the surge of mucormycosis: Lessons learnt and future preparedness: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

A сomplication of COVID-19 in the maxillofacial region. Сlinical cases

This study focuses on the clinical symptoms of inflammatory and destructive lesions of the facial skeletal bones as a long-term complication of coronavirus disease-2019 (COVID-19). The most common symptom of COVID-19 is thrombosis. Many scientists have noted that the main target of COVID-19 is the lungs with varying damage severity in the form of pneumonia. Acute cerebrovascular accidents and coronary pathology have become the most common causes of lethal outcomes in young people. Clinically, in patients with COVID-19, both obvious thrombotic complications were recorded with large thrombi detection (not only in the veins and pulmonary arteries, but also in the heart and vessels of the brain, kidneys, and liver), as well as signs of thrombosis at the microcirculatory level, which is quite difficult to establish in vivo. The diagnostics, treatment, and follow-up of a patient with COVID-19 history and complications that arose in the maxillofacial region were conducted in the Department of Maxillofacial Surgery of Clinical Hospital. Upon admission, the patient was diagnosed with chronic osteomyelitis of the upper jaw on the right, chronic right-sided maxilloethmoidal sinusitis, mucous membrane defect on the right hard palate, oroantral fistula on the right, and keratitis of the right eye. During the inpatient treatment, multicomponent therapy was performed. During the therapy, a general condition and local status improvement of the patient was noted.
 CONCLUSIONS: The clinical cases indicate that the course of COVID-19 is characterized by late complications in the maxillofacial region in the form of damaged vessels that extend from the а. maxillaris trunk in the pterygopalatine fossa region.
 The trophic disorder was slowly progressive and irreversible. The clinical and radiological presentation showed no clearly defined boundaries of bone necrosis of the facial middle zone. Low tissue regeneration was noteworthy.

Modified Inverted Periosteal Flap Versus Buccal Advancement Flap Technique for Oroantral Fistula Repair: A comparison

Oroantral fistula is a pathological and epithelised communication between pseudo stratified columnar ciliated epithelium of maxillary antrum and squamous epithelium of oral mucosa. Various techniques in literature point to the fact that repair of oroantral fistula is one of the most challenging problems in oral and maxillofacial surgery. Buccal advancement flap technique causes vestibular shortening, reduction in keratinized gingiva width with closure under tension thereby increasing the chances of wound dehiscence. On the other hand, Inverted periosteal flap preserves vestibular depth, maintains keratinized gingiva width providing true tension free closure. However, it is technically very challenging with maximum chances of perforation of delicate periosteal flap. A new Modified Inverted Periosteal Flap technique for oroantral fistula repair will eliminate all the potential complications and adverse effects of both the conventional buccal advancement flap and inverted periosteal flap procedures providing a true ideal closure.

The Recovery of Odontogenic Sinusitis after Endoscopic Sinus Surgery

Background and Objectives The present study was designed to investigate the normalization period of the maxillary sinus after endoscopic sinus surgery (ESS) for odontogenic sinusitis (ODS) and factors related to it. The thickness of the maxillary sinus mucosa may reflect the improvement of symptoms and may help determine when the dental implant procedure will be possible. Subjects and Method A total of 52 patients (34 males and 18 females) who were diagnosed with ODS and treated by ESS between 2014 and 2019 were enrolled in this study. The recovery status was defined as ‘improved’ when the mucosal thickness of the maxillary sinus was less than 4 mm measured by X-ray radiograph; ‘partially improved’ when it was 5 to 10 mm, and ‘little’ when it was more than 10 mm. The recovery period of the maxillary sinus after ESS was measured with an endoscope and X-ray radiograph and its related factors were analyzed. Results About 2.1±1.6 months were required for maxillary sinus to return to normal as investigated with an endoscope and X-ray radiograph. Assessed one month after ESS when compared to the three months after ESS, the results showed 100% recovery in ‘improved’ cases, 85.7% in ‘partially improved’ cases, and 50% in ‘little’ cases. ‘The mucosal thickness of the maxillary sinus one month after ESS’ (p<0.001), ‘oroantral fistula (OAF)’ (p=0.010), and ‘delayed extraction’ (p=0.028) were significantly related to the recovery period of the maxillary sinus by multiple regression analysis.Conclusion ODS responds well to the ESS, and the mean period for returning to normal maxillary sinus was 2.1±1.6 months. The normalization period of the maxillary sinus was positively correlated with the mucosal thickness of the maxillary sinus one month after ESS, OAF, and delayed tooth extraction.

A Novel Approach For Reconstruction Of Large Oro-antral Fistulae Defects With Simultaneous Sinus lift. (A Clinical Study)

Background: The Oro-antral fistulae (OAF) compromises the oral mucosa and the alveolar bone integrity, depleting its capacity to receive dental implants.Purpose: This clinical study aims to assess the clinical outcomes and the radiographic vertical bone gain of an innovative technique that combines the (OAF) closure, bone grafting, and sinus lift. Patients and methods: The study represents a case series conducted on thirteen patients with large (OAF), closed by sliding the buccal advancement flap combined with a distant palatal releasing incision after inverting and elevating the fistulous epithelial tract to set, elevate and conceal the floor of the maxillary sinus from the underlying bone graft. Meanwhile, evaluating the clinical outcomes and justifying a radiographic linear bone height comparison between the sinus floor height preoperatively and three months after. Results: The healing went uneventful, with neither shallowing of the vestibular depth nor obliterating the sinus cavity. The bony sinus floor was admirably elevated, and the grafted defects demonstrated appropriate bone width and height. The mean baseline bone height recorded (9.28 ±2.4 mm) versus ( 17.54 ± 1.6 mm ) for the three months postoperative. The vertical bone gain ranged from (4 to 12.5 mm), with a mean of ( 8.26 ± 2.6 mm), computing a statistically significant linear gain increase ( p < 0.00001). Conclusion: The novel approach provided comprehensive coverage of the oral defect, an appropriate primary elevation of the maxillary sinus with consolidated alveolar graft, cutting short the routine treatment time with the conduction of significant linear bone height gain values.

Comparison of two Surgical Procedures in the Management of Oroantral Fistula

Objective: To compare between double layer closure and buccal advancement flap in the management of Oro-antral fistula. Methodology: This Comparative cross sectional study was conducted on 30 patients with oral antral fistula in Maxillofacial Surgery Department, Liaquat University of Medical & Health sciences Hyderabad. The study was conducted from March 2013 to February 2019. Selection of patients was made on inclusion criteria of patient having OAF for more than 15 days, irrespective of location and side. Patients who developed Oro-antral fistula (OAF) because of any pathology or its treatment, and patient having bleeding tendency were excluded. Division of two groups to avoid any bias in this study was done by using random number table. Group-I was treated with buccal advancement flap while group-II with “double layer closure “with buccal fat pad” and 2nd layer with buccal advancement. The outcome was evaluated for any postoperative complications like wound dehiscence, necrosis, infection. Results: Males and females were 67% and 33% respectively. The mean age was 35.03±9.56 years. Maxillary molars were the common site for OAF. Maxillary first molar followed by second molar site was ranked according to frequency of this condition. Buccal advancement procedure was used in group A and in this cluster 86.6% cases were successful. In Group B, a double layered closure procedure was used and the success rate was 93.3% which is statistically not significant. Conclusion: Double-layered closure using BFP with buccal advancement flap should be kept as a valuable option in mind in the management of OAF. Key Words: Buccal Advancement Flap, Oro-Antral Fistula, Buccal Fat Pad, Double Layered Closed Technique.

THE OROANTRAL FISTULA: A CASE REPORT

Introduction: An unnatural communication between the maxillary sinus and oral cavity is known as “oroantral communication”(OAC) and if it does not close spontaneously, it is epithelialized so that oroantral fistula develops.(2) The most common cause of oroantral fistula is the extraction of a maxillary molar or premolar.(2,11) The close relationship between the apex of these teeth and the thinness of the antral floor explains this.(11) From simple local methods like buccal advancement flap to complex distal flaps and grafts, various methods have been described in the literature for the closure of these communication.(2) To facilitate gravitational drainage and aeration via an inferior meatal antrostomy and to remove irreversibly damaged mucosa of the maxillary sinus, Caldwell Luc procedure was designed.(10) Objective: To describe a case report of oroantral fistula [OAF] and its closure. Case Report: We repot a case of 28 years old male patient who came to our attention for the presence of the OAF and presence of maxillary third molar root piece in the maxillary sinus. This patient was treated by“ OBTURATOR procedure.”