Oroantral Communication Research Articles

Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws.

The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20-70years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

English

Patients who undergo surgical resection of the maxillo-mandibular structures as a result of trauma, infection or malignancy, suffer from psycho-social setbacks which has a profound impact on their over-all quality of life. 1,2 These defects, especially those following maxillectomy, result in oroantral communication, facial deformation, impaired speech and difficulty in deglutition. For the rehabilitation of patients with such defects, surgical and prosthetic treatment options are available. As, not all patients can be successfully rehabilitated with reconstructive surgeries due to postoperative complications like graft rejection, the extent of the surgical defect and high psychological impact factor associated with repeated surgeries, prosthetic rehabilitation proves to be an alternative treatment option. The prosthetic rehabilitation of such patients is challenging as it requires restoration of the lost form, function and aesthetics, under constantly changing state of post-surgical intraoral tissues, with limited mouth opening. The maxillofacial prosthesis designed to close congenital or an acquired tissue opening, primarily of the hard palate, is known as an obturator. 3 The obturator has two functional components, one seals the surgical defect and the other replaces the lost dentoalveolarstructures.4-7 The design of an obturator may vary depending on the extent of the defect, remnant dentoalveolar complex, soft tissue undercuts and existent muscle physiology.8,9 Among the two designs, solid and hollow, hollow obturators are widely used. The bulb portion of the hollow obturator, which accommodates the surgical defect, can be open or closed9,10and its selection depends on the prosthodontist’s clinical decision-making skills and the ease of fabrication. In this article we have discussed the rehabilitated patients with single-piece, openhollow bulb definitive obturator. Patients undergo extensive maxillary surgical resections due to aggressive lesions like malignancies and deep fungal infections. Prosthetic rehabilitation of such patients with an obturator becomes of paramount importance as it separates the oropharynx from the nasopharynx, reduces the risk of recurrent infections, replaces lost dentoalveolar structures, permits intelligible speech, reinstates mastication and deglutition, restores facial contour and patient’s self-esteem. The bulb portion of the obturator extends into the defect and accommodates it, forming a hermetic seal. In this clinical report, we highlight the success of prosthetic rehabilitation of maxillectomy patients using single-piece, open-hollow bulb definitive obturator. The meticulous follow-up carried out reveals the success of the prosthesis and adds practice-based evidence to the maxillectomy rehabilitation outcome.

Analysis of complications after the removal of 339 third molars.

Extractions of third molars constitute about 90% of the scheduled surgical procedures performed by oral surgeons. Wisdom tooth surgery is associated with complications, such as the lingual and inferior alveolar nerve damage, bleeding, tooth/jaw fractures, tooth displacement into the adjacent anatomical spaces, trismus, infections, and other. The aim of the study was to analyze complications after wisdom tooth extraction in patients treated at the Department of Oral Surgery of Jagiellonian University Medical College in Kraków, Poland, in the years 2016-2018. A retrospective analysis of the medical records of 339 patients treated in the outpatient setting was performed. The inclusion criterion comprised a single extraction of a third molar. The exclusion criteria were multiple extractions, comorbidities and pregnancy. No antibiotic prophylaxis was used. The incidence of post-extraction complications, such as oroantral communication, postoperative hematoma, acute inflammation of the surrounding tissues, trismus, and transient paresthesia in relation to patient gender and age, the developmental stage and location of the removed tooth as well as the type of surgery were studied. Perioperative complications occurred in 51 (15.0%) cases, and comprised the acute inflammation of the surrounding tissues in 31 patients, trismus after the removal of 13 lower third molars, oroantral communication after the extraction of 5 upper wisdom teeth, and hematoma as well as a transient sensory alteration of the lingual nerve in 1 case each. Complications were more common in patients who had a surgical extraction of a wisdom tooth with root separation and in cases of lower third molar extractions. No statistically significant correlation was found between the patients' age or gender, the developmental stage of the extracted tooth and the number of observed complications. Lower third molars and the necessity of surgical extraction with root separation are risk factors for postoperative complications in patients who require wisdom tooth removal. Complications after the removal of third molars are most often inflammatory.

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.”

Use of the temporal extension of the buccal fat pad for closure of oro-antral communications

Oro-antral communications/fistulae (OAC/OAF) can cause significant patient morbidity, with treatment for defects greater than 5mm in size requiring surgical reconstruction. This technical note evaluates the effectiveness, and proposes the use of, the temporal extension of the buccal fat pad (TEBFP) for the closure of large OAC. The TEBFP can be an effective means of large OAC closure due to its ease of harvesting, with minimal damage to surrounding structures or aesthetic changes. The use of the TEBFP provides stability, versatility, and tension-free closure, with minimal postoperative complications.

Management of Oroantral Communications.

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.

Non-radiation and non-drug–induced maxillary osteomyelitis: Study of underlying risk factors, presentation, management and treatment outcomes

BackgroundOsteomyelitis of the jawbone is mostly secondary to radiation exposure or bone remodelling drugs, with the mandible being commonly involved. Maxillary osteomyelitis risk is low owing to its high vascularity. This study was undertaken to evaluate risk factors, presentation, management and outcomes of maxillary osteomyelitis caused due to reasons other than irradiation and bone remodelling drugs. MethodsPatient records diagnosed with maxillary osteomyelitis were evaluated for demographic details, risk factors, clinical presentation, radiological features, treatment performed and outcomes. ResultsIn 38 patients with non-irradiated and non-drug–induced osteomyelitis, 13 involved the maxilla, seven were localized to the posterior maxilla and 10 showed paranasal sinus involvement. Dissemination to the cavernous sinus and cerebral spread was seen in one. Clinical findings included oroantral communication, pain and draining sinus. Imaging showed diffuse bone destruction areas with or without evidence of bony sequestrum. The most common systemic risk factor was diabetes mellitus. Maxillary osteomyelitis was associated with tooth extraction in eight cases. Surgical management included debridement, sequestrectomy, functional endoscopic sinus surgery, maxillectomy and reconstruction of soft tissue defect with local and regional flaps. Complete recovery was seen in 11 patients. Mortality was seen in two patients with mucormycosis having disseminated infection. ConclusionCompared with previous literature, a relatively higher ratio of maxillary involvement was reported. Diabetes mellitus was the most common risk factor, followed by osteopetrosis and tooth extraction. Osteomyelitis secondary to mucormycosis in immunocompetent patients was relatively localized and gave favourable response to management compared with patients with diabetes mellitus.

Rehablitation of a maxillectomy patient with hollow bulb obturator: A case report

God has given beautiful face and smile to human being. It is right of every individual to look good. If an individual lost his/her facial part due to certain cause, it has to be restored immediately. Patient will face severe mental trauma and functional disability after maxillofacial structure loss. Post-surgical maxillary defects pre-dispose the patient to hypernasal speech, fluid leakage into the nasal cavity, and impaired masticatory function. Such defects need special prosthesis to establish oro-nasal seal and rehabilitate the patient. After maxillectomy, the prosthodontist treats the defect with obturator. The obturator takes the retention from remaining teeth, undercut areas and scar bands around the defect. In this article, a technique for creating an interim maxillary hollow bulb obturator that engages the remaining teeth, undercut areas and scar band around the defect is described. Keywords: Maxillectomy, Obturator, Oroantral communication, Interim obturator, Pre-maxilla defect.

Surgical Field Isolation Through Rubber Dam to Prevent COVID-19 Exposure During Tooth Extraction: Case Report

Background: At the beginning of 2020, a new pathogen named SARS-CoV-2 spread from China to the globe, becoming responsible for a potentially lethal acute respiratory syndrome: COVID-19. Direct contact and airborne contamination are the most frequent infection ways of SARS-CoV-2. During routine dental practice, SARS-CoV-2 transmission can occur through direct contact with mucous membranes, oral fluids, and contaminated instruments or inhalation of aerosol from infected patients. Introduction: Tooth extraction often involves exposure to blood and oral fluids, and the use of a rubber dam could be indicated to minimize direct contact and to decrease the amount of potentially infected droplets around the operatory field. The aim of this clinical case is to show how the use of a rubber dam could help in preventing or minimizing COVID-19 exposure during dental extraction. Materials and Methods: A 32-year-old patient reported severe pain and discomfort to an upper first molar due to a deep carious lesion and vertical tooth fracture. Under local anaesthesia, a rubber dam was placed, isolating the whole upper right sextant, and an atraumatic extraction was performed. Results: All three roots were intact, the bone septum was stable, and no oro-antral communication was present. A gauze swab was placed onto the socket and compressed slightly. After 5 minutes, the socket stopped bleeding, and both clamp and rubber dam, were removed. Conclusion: Within the limits of this single case report, the use rubber dam prior to tooth extraction could be a useful device to decrease aerosol spread and exposure to blood.

Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up

This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction.The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined.A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund–Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm.According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.

Causes and treatments of oroantral communications: Experience with 103 cases

Aim: In this study, we aimed to evaluate the etiologic factors, location and surgical technique for patients with oroantral communications (OAC).Materials and Methods: A total of 103 patients who had chronic or acute OAC and underwent surgical correction were reviewed retrospectively. The data that was recorded included gender, age, fistula location, fistula size, duration of the fistula, etiology, treatment modality, and any related complications. Results: Extraction of the first molar is associated with the highest incidence (41.75%) of OACS. Complete healing was observed in 68 patients with suturing. Surgical intervention was necessary for 35 patients. The surgical methods used for closure of the OACS included palatal-rotational flaps (PRF) in two patients, buccal flaps (BF) in 18 patients, and Bichat’s buccal fat pad (BFP) in 15 patients. Treatment in 5 cases resulted in failure, and four of these patients received a second treatment. In one case the patient refused any further surgical intervention and was treated with an obturator prosthesis. Conclusion: Location, size of the defect, and duration of the OAC are essential factors in the choice of technique. Surgeons should choose the correct approach or modify it in accordance with the characteristics of the particular OAC.

Oroantral communication, its causes, complications, treatments and radiographic features: A pictorial review.

PurposeAn oroantral communication (OAC) is an abnormal space between the maxillary sinus and oral cavity. The causes, complications, treatment, and radiographic features of OAC in 2-dimensional and 3-dimensional imaging modalities are discussed.Materials and MethodsThis pictorial review presents a broad spectrum of imaging findings of OAC. Representative radiographs depicting OAC were chosen from our database. PubMed was used to conduct a comprehensive literature search of OAC.ResultsCharacteristic features of OAC include discontinuity of the maxillary sinus floor, thickening of the maxillary sinus mucosa, or a combination of both. Two-dimensional imaging modalities are the method of choice for identifying discontinuities in the maxillary sinus floor. However, 3-dimensional imaging modalities are also essential for determining the status of soft tissue in the maxillary sinus.ConclusionThe integration of 2-dimensional and 3-dimensional imaging modalities is crucial for the correct diagnosis and comprehensive treatment of OAC. However, the diagnosis of OAC must be confirmed clinically to prevent unnecessary mental and financial burdens to patients

Izrada opturator parcijalne proteze nakon subtotalne maksilektomije - prikaz slučaja

Introduction: Maxillary resection opens oronasal and/or oroantral communication, which seriously complicates various functions of the orofacial system, chewing, swallowing and speech. In addition, the symmetrical and pleasant appearance of the patient, his mental state, working ability and social life are disturbed. Case report: The manuscript shows a patient who was prosthetically repaired after a partial maxilectomy. Conclusion: The close cooperation of a maxillofacial surgeon and a specialist in prosthodontics can result in the removal of the changes on the maxilla and the creation of an obturator denture that improves the functions of the orofacial system and the quality of life of the patient in general.

Post-COVID mucormycosis: Ascertainment of the pathological diagnostic approach.

Post-COVID mucormycosis: Ascertainment of the pathological diagnostic approach.

Closure of oro-antral communication using buccal adipose body: case report in elderly patient.

Closure of oro-antral communication using buccal adipose body: case report in elderly patient.

Prosthetic Management of Oroantral Communication: A Case Report

Oro-Antral Communication (OAC) is an abnormal communication between the maxillary sinus and the oral cavity. It may be the result of different pathological processes and often occurs following an extraction. This article presents a case of closure of OAC followed by a failed palatal flap. A maxillary obturator was designed and fabricated in heat polymerized acrylic resin. The treatment should always be individualized and planned to avoid failures and promote fast healing.

A definitive approach to rehabilitate acquired maxillary defect- A case report

Removal of tumors, carcinomas, trauma and congenital malformations results in acquired maxillary defects which greatly effect patients quality of life and self-esteem. Hemimaxillectomy patients mainly faces problem of mastication, phonetics and swallowing due to oro-antral communication. Prosthetic rehabilitation of hemimaxillectomy conditions can be challenging to prosthodontist and requires multidisciplinary approach for comprehensive care and treatment. Depending on size and location of the defect the amount of impairment and difficulty in prosthetic rehabilitation is seen. Hollow obturator prosthesis is most commonly used for rehabilitating hemimaxillectomy cases as an effective treatment. This case report discusses designing of cast partial denture and fabrication of hollow obturator prosthesis for above said condition to overcome problems like speech, swallowing, mastication and to improve quality of life. Keywords: Hemimaxillectomy, Obturator, Prosthetic rehabilitation.

Buccal abscess derived from subcutaneous emphysema caused by the Valsalva maneuver after oral surgery with pedicled buccal fat pad grafting

AbstractPedicled buccal fat pad grafting is applied in a variety of oral surgeries, including the reconstruction of oral defects or the closure of oroantral communication. Pedicled buccal fat pad grafting is a well‐established and relatively safe procedure; however, it may cause complications such as swelling, hematoma and/or infection. There are few reports on the detailed cause and clinical course of these complications. This report discusses the Valsalva maneuver as a cause of complications after oral surgery with pedicled buccal fat pad grafting. A 77‐year‐old man underwent pedicled buccal fat pad grafting for oroantral communication after sequestrectomy for medication‐related osteonecrosis of the maxilla. Postoperatively, the performance of the Valsalva maneuver during defecation caused facial subcutaneous emphysema, hematoma and buccal abscess formation. The abscess could not be treated by antibiotics alone, and required surgical drainage. Prominent subcutaneous emphysema is associated with bleeding due to blood vessel damage, and may cause a large hematoma, especially in patients receiving antithrombotic therapy. Hematomas are susceptible to infection, and infections in the buccal space are often severe due to the tissue continuity in deep spaces. Therefore, buccal abscesses after pedicled buccal fat pad grafting require surgical drainage. This case report suggests that performing the Valsalva maneuver during defecation may cause complications after pedicled buccal fat pad grafting. Patients should be informed that the Valsalva maneuver could lead to serious complications, and that all types of the Valsalva maneuver should be avoided postoperatively.

Outcome of first-time surgical closures of oroantral communications due to tooth extractions. A retrospective analysis of 162 cases.

The objective of this study was to analyze the outcome of first-time surgical closures of oroantral communications (OAC) after tooth extractions. Using a billing software, all patients treated in a surgery department were filtered for interventions of the maxillary sinus indicative of OAC therapy. Out of 221 initially eligible cases, the charts of 162 cases fulfilling the inclusion criteria were retrospectively evaluated for the outcome in terms of symptom-free OAC closure as well as possibly influencing patient and treatment factors. The analyzed cohort included 98 males (60.5%) and 64 females (39.5%) with a mean age of 48.6 years (range 17 to 86 years). The maxillary 1st molar (38.3%) was the most common site requiring OAC closure. In 60.5% of the cases, surgical OAC closure was performed immediately after tooth extraction. The Rehrmann flap (72.2%) was the most frequently used technique for surgical OAC closure. 94.4% of surgical OAC closures were successful. Gender and age did not influence the outcome. In contrast, the site of OAC and the time interval from tooth extraction to OAC closure affected the results. Furthermore, the Rehrmann flap, alone or in combination with biomaterials, was superior to the mere suturing (with or without biomaterials) of the OAC site. In conclusion, the Rehrmann flap alone or in combination with biomaterials provided high success rates for first-time surgical OAC closure. With regard to the study parameters, an OAC in the 3rd molar area and an extended interval from tooth extraction to OAC closure negatively influenced the resolution of OAC. However, results must be interpreted cautiously considering the retrospective study design and the limited number of cases.

Outcome of first-time surgical closures of oroantral communications due to tooth extractions. A retrospective analysis of 162 cases.

The objective of this study was to analyze the outcome of first-time surgical closures of oroantral communications (OAC) after tooth extractions. Using a billing software, all patients treated in a surgery department were filtered for interventions of the maxillary sinus indicative of OAC therapy. Out of 221 initially eligible cases, the charts of 162 cases fulfilling the inclusion criteria were retrospectively evaluated for the outcome in terms of symptom-free OAC closure as well as possibly influencing patient and treatment factors. The analyzed cohort included 98 males (60.5%) and 64 females (39.5%) with a mean age of 48.6 years (range 17 to 86 years). The maxillary 1st molar (38.3%) was the most common site requiring OAC closure. In 60.5% of the cases, surgical OAC closure was performed immediately after tooth extraction. The Rehrmann flap (72.2%) was the most frequently used technique for surgical OAC closure. 94.4% of surgical OAC closures were successful. Gender and age did not influence the outcome. In contrast, the site of OAC and the time interval from tooth extraction to OAC closure affected the results. Furthermore, the Rehrmann flap, alone or in combination with biomaterials, was superior to the mere suturing (with or without biomaterials) of the OAC site. In conclusion, the Rehrmann flap alone or in combination with biomaterials provided high success rates for first-time surgical OAC closure. With regard to the study parameters, an OAC in the 3rd molar area and an extended interval from tooth extraction to OAC closure negatively influenced the resolution of OAC. However, results must be interpreted cautiously considering the retrospective study design and the limited number of cases.