Oroantral Fistula Research Articles

Iatrogenic Rhinolith: A Case Report and Review of Literature.

Unilateral nasal obstruction is a common complaint with a broad differential diagnosis that includes anatomic asymmetry, unilateral infective or inflammatory conditions, and benign and malignant sinonasal masses. A rhinolith is an uncommon foreign body in the nose, which serves as a nidus for calcium salt deposition. The foreign body can be endogenous or exogenous in origin and may remain asymptomatic for many years before incidental discovery. When left untreated, stones may cause unilateral nasal obstruction, rhinorrhea, nasal discharge, epistaxis or, in rare cases, progressive destruction leading to septal/palatal perforation or oro-antral fistula. Surgical removal is an effective intervention with limited complications reported. This article describes a 34-year-old male who presented to the emergency department (ED) with unilateral obstructing nasal mass and epistaxis, which was found to be an iatrogenic rhinolith. Successful surgical removal was performed. Epistaxis and nasal obstruction are common presentations to the ED. Rhinolith is an uncommon clinical etiology that if left undiagnosed may lead to progressive destructive disease; it should be included in the differential for any unilateral nasal symptoms of unclear origin. Appropriate work-up for any suspected rhinolith includes computed tomography, as biopsy is risky given the broad differential of unilateral nasal mass. When identified, surgical removal has a high success rate with limited complications reported.

Odontogenic Sinusitis with Oroantral Communication and Fistula Management: Role of Regenerative Surgery.

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.

Primary odontogenic onset invasive mucormycosis—an under recognized clinical entity

ObjectivesThe primary source of facial mucormycosis is through inhalation of fungal sporangiospores, resulting in invasive disease in paranasal sinuses. However, dental onset mucormycosis has not been well documented in literature. The aim of this study was to describe the clinical characteristics and outcomes of patients with odontogenic onset mucormycosis. MethodsFrom a large cohort of mucormycosis involving the face between July 2020 and October 2021, we selected patients who had dental symptoms at onset and predominant alveolar involvement with little to no paranasal sinus disease as shown by baseline imaging. All patients had a confirmed diagnosis of mucormycosis through histopathology, with or without the growth of Mucorales in fungal culture. ResultsOut of 256 patients with invasive mucormycosis of the face, 8.2% (21 patients) had odontogenic onset. Uncontrolled diabetes was a common risk factor, affecting 71.4% (15/21) of the patients, while recent COVID-19 illness was noted in 80.9% (17/21) of patients. The median duration of symptoms at presentation was 37 days (IQR, 14–80 days). The most common symptoms were dental pain with loose teeth (100%), facial swelling (66.7% [14/21]), pus discharge (28.6% [6/21]), and gingival and palatal abscess (28.6% [6/21]). Extensive osteomyelitis was found in 61.9% (13/21) of the patients, and 28.6% (6/21) had oroantral fistulas. The mortality rate was low, at 9.5% (2/21), with only 9.5% (2/21) of the patients having brain extension and 14.2% (3/21) in the orbit. ConclusionThis study suggests that odontogenic onset invasive mucormycosis may be a separate clinical entity with its own distinct clinical features and prognosis.

Sinus culture differences in patients with radiographic evidence of odontogenic disease

PurposeOdontogenic sinusitis is a well-known entity with a different pathogenesis than chronic rhinosinusitis. Nonspecific symptoms can make diagnosis difficult. This study aims to compare culture results between patients with and without computed tomography findings indicative of possible odontogenic disease. Materials and methodsThis was a retrospective cohort study in which patients undergoing endoscopic sinus surgery for chronic sinusitis over a three-year period at a single institution were reviewed. CT imaging was reviewed for evidence of dental disease, specifically periapical lucency, dehiscence of the floor of the maxillary sinus, oroantral fistula, or foreign body. Culture results were then assessed and compared between groups with CT evidence of a possible odontogenic source to those without. ResultsOverall, 231 patients were evaluated. 92 patients (39.8 %) were found to have evidence of a likely odontogenic source on CT. Cultures were available for 118 of 231 patients (51.1 %). Patients with CT signs of odontogenic disease were significantly more likely to grow Proteus mirabilis (p = 0.018) and Klebsiella pneumoniae (p = 0.037) on culture. Patients without CT signs of odontogenic sources were significantly more likely to grow Pseudomonas aeruginosa (p = 0.009). Of note, patients with CT findings concerning for an odontogenic source were also more likely to grow fungi other than Aspergillus and Mucor species on culture (p = 0.004). ConclusionPatients with CT findings concerning for an odontogenic source of sinus disease showed differences in culture results that could be important in differentiating pathogenesis of sinus disease.

A case series on allergic fungal rhino sinusitis – variable presentations

Allergic fungal rhino sinusitis (AFRS) is a non-invasive fungal sinusitis resulting from an allergic and immunologic response to the presence of extramucosal fungal hyphae in the sinuses. Defined largely by the presence of allergic fungal mucin, which is a thick, tenacious, and eosinophilic secretion with characteristic histologic findings. To present a case series on the variable presentations in patients diagnosed with AFRS. A retrospective study of 10 cases that presented to Rajiv Gandhi Government General Hospital ENT outpatient department with allergic fungal rhinosinusitis confirmed by diagnostic nasal endoscopy and CT scan who were managed successfully by endoscopic sinus surgery. In our study, out of 10 cases, nine patients had unilateral symptoms, only one patient has bilateral symptoms. Most common presentation was headache, facial pain, nasal obstruction, and nasal discharge. Some patients had variable presentations such as proptosis, oroantral fistula, blurring of vision, watering of eye, and unilateral frontal headache. On diagnostic nasal endoscopy, two patients had nasal polyposis. Complete disease clearance was achieved in nine cases by functional endoscopic sinus surgery. Patients were started on topical and oral corticosteroids, pre/postoperatively. On follow-up, only one patient had recurrence. Preventing and treating the condition, as well as its spread and complications, are greatly aided by early detection and management of AFRS. The key to enhancing the result is surgical intervention (endoscopic sinus surgery) and medical therapy (corticosteroids). Antifungals have limited role in treatment of AFRS. Longstanding unilateral Sinusitis should always raise suspicious of AFRS.

Dermal Regeneration Template: Reconstruction in Oral Cancer Defects

BackgroundPost ablative oral mucosal defect resulting from the removal of tumors can be treated with various techniques.PurposeIn this paper, we are showing what, in our experience, are the advantages and disadvantages given using biosynthetic skin substitutes when dealing with this kind of lesions.Materials and methodsPatients included in the sample came to our attention with both neoplastic lesions (11 subjects) and important scar retraction after previous oncologic surgery (1 subject). All patients underwent trans-oral resection surgery following the same surgical protocol and post ablative oral mucosal defect were treated using the dermal regeneration template. The surgical defect location, size, and time of removal of the silicone layer varied from one subject to the other.ResultsMost patients showed good healing with reduced scarring and adequate remucosalisation of the defect. The main complications were shown in a palatal lesion treated with concomitant osteal resection, which developed an oroantral fistula at follow up, and tongue lesions which showed some scarring.ConclusionsGiven our experience, we would advise using dermal substitutes when reconstructing oral defects only after a cautious evaluation of the area of the lesion, the gap size, the possible adherence of the membrane to the gap, and the presence of tissue supporting the overlying membrane.

Evaluation of the Effectiveness of Collagen Membrane in the Management of Oro-Antral Fistula/Communication - A Clinical Study

Background: The opening adjoining maxillary sinus with the oral cavity is termed as Oroantral Communication (OAC) which when left untreated leads to oroantral fistula or maxillary sinusitis. Surgical closure within 48 hours is recommended for OAC to circumvent complications like sinus infections. The current study is designed to evaluate collagen membranes for the treatment of OACs which was reported as a safe and easy procedure. Method: The study was conducted with the patients who needed the management for Oroantral Fistula/Oroantral Communication (OAF/OAC) which developed following the posterior maxillary tooth removal. To cover OAF/OAC with a collagen membrane, Bio-Gide (GTR/GBR Collagen Membrane) was inserted in the socket. The particular membranes were then attached using sutures to the adjoining gingiva, and medication like Amoxicillin 500 mg, Metronidazole, nasal decongestant drops and steam inhalation were prescribed for one week to each patient. After day 7, sutures were removed. Patients were checked following the first, third, six weeks and third month. Data were statistically analyzed and an Independent T-test was performed. Results: All the patients accepted Bio-Gide (GTR/GBR Collagen Membrane) perfectly, soft tissue was recovered completely without any problem. Soft tissue was completely epithelialized in the defective area for all the samples. No relapse was reported in any of the patients following a 3- month follow-up. Conclusion: Bio-Gide (GTR/GBR Collagen Membrane) technique is simple and effective for treating OACs with a diameter of 5 mm or less and with negligible complication.

A case of oroantral fistula: managed successfully by buccal advancement flap

Oral epithelium migrates into the defect when an oroantral communication lasts more than three weeks, at which point it is referred to as an oroantral fistula. Oroantral fistula (OAF) can arise for a variety of reasons, including the extraction of maxillary posterior teeth, treatments for sinus augmentation, the improper use of implant drills, trauma to the craniofacial region, osteoradionecrosis, and flap necrosis. The size of the pre-existing oroantral communication affects the oroantral fistula’s treatment strategy and outcome. Instances when the oroantral communication is lesser than 2 mm in diameter it’s likely to heal and close by itself, eliminating the need for any surgical intervention. However, surgical closure is advised when the oroantral communication is higher than 3 mm or linked to periodontal or maxillary infection. In the literature, a number of algorithms have been proposed to describe the surgical methods for treating oroantral fistulas. This article aims to discuss a case of oroantral fistula of a female patient aged 34 years who presented with the chief complaint of foul discharge from the nose since 2 months.

The Evaluation of Clinical Signs and Symptoms of Malignant Tumors Involving the Maxillary Sinus: Recommendation of an Examination Sieve and Risk Alarm Score.

This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients (52.9%), and oroantral fistula was noted in 37 patients (55.9%). Additionally, 67 (95.7%) of the patients complained of nasal obstruction. Similarly, facial asymmetry was observed in 69 (98.6%) of the patients and double vision was observed in 24 (34.4%). Tumors of the maxillary sinus have a very insidious course of spread and uncertain clinical signs and symptoms. What makes diagnosis worse is the fact that the symptoms of these tumors are so well hidden in the sponge-like nature of the midfacial region that they are easily misinterpreted by patients. Therefore, diagnoses must be made early, dentists must be vigilant, and patients must be fully investigated at the slightest suspicion of a tumor, albeit benign.

Surgical Approach to Odontogenic Maxillary Sinusitis Caused by Tooth Root Displacement into the Maxillary Sinus: A Case Report

Paranasal sinuses affected by foreign bodies are uncommon clinical situations. Foreign body displacement into facial sinuses is a potential iatrogenic complication, that may cause an oroantral fistula, sinusitis, cellulitis, and subdural emphysema. The maxillary sinus is usually the most affected by tooth displacements, due to its proximity. A dental fragment in the maxillary sinus may cause Odontogenic Maxillary Sinusitis (OMS). The present case report presents a case from the diagnosis to treatment of OMS originated by a fragment of tooth root displacement into the sinus during a previous dental extraction. A female patient, 13-yearold, had characteristic signs of sinusitis, reporting rhinorrhoea, headache, eye pain, and pain on the left side of the face. The clinical examination showed pain on palpation in the buccal region of the upper left first molar, which was absent. The Cone Beam Computed Tomography (CBCT) showed a foreign body inside the maxillary sinus, complete opacification, and bone defect on the sinus floor. Given the final diagnosis of OMS, the treatment selected was the combination of antibiotic therapy and fragment removal from the sinus. The diagnosis, planning, and correct use of surgical techniques described in the literature are essential for preventing iatrogenesis and actively ensuring patient health. In this sense, patients need to be informed about any complication, which should be written in the medical records along with resolution measures.

Lateral Window Maxillary Sinus Augmentation – Complications and Management

Introduction: The sinus lift procedure is the most predictable surgical intervention for enhancing bone quality and quantity in the posterior maxilla prior to the placement of endosseous dental implants. However, despite careful planning and precise surgical technique, several complications can arise. These include - haemorrhage, membrane perforation, infection, wound dehiscence, post operative pain, implant failure/ loss, graft loss, hematoma, barrier membrane exposure, oroantral fistula and sinusitis. Aim: The purpose of this report was to address the most common complications associated with the sinus lift procedure and discuss how to avoid and manage them when they occur. Methodology: A total of 140 articles from peer reviewed journals published in English from January 1986 to January 2023 were collected from a search performed using MEDLINE and PubMed. The keywords utilized were “dental implant”, “sinus augmentation”, “sinus complication”, “membrane perforation”, “bleeding – sinus augmentation”. Twenty-nine of the 140 articles satisfied the inclusion criteria and were utilized in this article. Results: Sinus membrane perforation is the most prevalent complication of maxillary sinus augmentation procedures, ranging from 11-60%. An incidence of 28% perforation rate is found. Bleeding was reported with an incidence of 2% of the sinus procedures performed. The use of piezoelectric devices as well as other measures play an important role in ensuring the stopping of bleeding. Conclusion: Proper planning and management of these complications will minimize the negative effects on therapy and allow for a successful implant result when placed in augmented maxillary sinuses.

Chronické rinosinusitidy odontogenní etiologie

Chronic rhinosinusitis is a common disease of the nose and paranasal sinuses. We note diseases of dental origin occurring with an increasing regularity. This cause tends to be overlooked. Treatment is longer and more complicated compared to rhinogenic sinusitis due to the higher prevalence of anaerobic bacteria. The treatment can be divided into two main steps. The first is to remove the cause of the odontogenic infection itself, followed by the remediation of secondary nasal cavities using functional endoscopic surgery (FESS). In order to treat this disease properly, inter-disciplinary cooperation between an otorhinolaryngologist and a dentist or oral surgeon is necessary. Conclusions of this paper is to highlight the idea of treating these two seemingly separate issues and procedures into one functional unit that will be most effective and least burdensome for the patient. From my point of view, it seems ideal to address this issue comprehensively. This shortens the treatment time and eliminates the need for the patient to move between different departments. Keywords: apical periodontitis – odontogenic sinusitis – oroantral fi stula – maxillary sinusitis of dental origin – endoscopic sinus surgery – root canal infection

Actinomycotic Osteomyelitis and Myiasis in Oroantral Communication: Clinicopathological and Tomographic Findings

Actinomycotic osteomyelitis of the maxilla presenting with oroantral communication is very rare, herein we report the first case of this condition in association with myiasis. A 50-year-old man reported chronic sinusopathy and a non-healing maxillary lesion, with 30 years of evolution, presenting occasional nasal and intraoral purulent discharge, with foul smell, and recurrent episodes of larvae presence. Cone beam computed tomography showed a large hyperdense image inside the left maxillary sinus, with focal areas with soft tissue density, and extensive discontinuity of the maxillary sinus floor, confirming the oroantral fistula. The necrotic tissue curetted during surgery presented hard consistency, and dark greenish color, and was submitted for histopathological analysis. Microscopically, necrotic bone, masses of filamentous bacteria colonie s, compatible with actinomycosis, and large rhomboidal structures surrounded by eosinophilic capsule - suggestive of larvae, were observed. The diagnosis of actinomycotic osteomyelitis with presence of structures compatible with larvae was established.

Removal of dental implants displaced into the maxillary sinus: a retrospective single-center study

BackgroundThe use of dental implants in the prosthetic rehabilitation of the posterior atrophic maxilla might be a challenge procedure because of low bone quantity and quality. This study aimed to report cases of implant displacement or migration into the maxillary sinus treated from 2008 to 2021.Materials and methodsAll patients with unintentional insertion and/or displacement of dental implants into the maxillary sinus cavity that underwent surgical removal were included. Variables assessed included the patients’ characteristics, past medical history, clinical and radiological findings at presentation, surgical approach (transoral, transnasal, combined), and outcome.ResultsA total of forty patients (23 male, 17 female) underwent surgical removal of dental implant displaced in the maxillary sinus. The mean age was 52,3 + 11,3 years. Seven patients presented with oro-antral fistula (OAF). In 15 cases, an ostium obstruction was diagnosed. Twenty-five patients underwent transoral surgery under local anesthesia. Eleven patients were treated solely via transnasal endoscopic approach, and four patients who had an associated OAF underwent surgery through a combined transnasal and transoral approach. All patients healed uneventfully without complications.ConclusionThese results and recent literature validate that transoral and transnasal approach, or a combination of these procedures, can be used safely to treat complications following displacement/migration of dental implants in the maxillary sinus. Early surgical removal minimizes sinus inflammation and prevents more invasive procedures. Each procedure presents specific indications that must be carefully evaluated prior to treatment choice to optimize intervention outcomes.

Efficacy of Crushed Delayed-Release Posaconazole Tablets in Rhino-Orbito-Cerebral Mucormycosis.

A significant proportion of patients with Rhino-orbito-cerebral mucormycosis (ROCM) develop oroantral fistulas. Due to the unclear efficacy of crushed delayed-release posaconazole tablets (DRPT) via nasogastric tube in this group of patients, clinicians often use inferior alternatives like posaconazole suspension. In this prospective study, we report good plasma concentrations (median, 2,639 ng/mL; interquartile range [IQR], 1,690 to 3,575 ng/mL; and range, 1,004 to 4,835ng/mL) and complete cure and survival at 3 and 6 months in 19 such patients.

Поражение органа зрения при болезни Вегенера. Клинический случай

The article provides a description of clinical case of patient 53 years old with Wegener's granulomatosis, manifested with necrotizing scleritis of the left eyeball against the background of malignant nose granuloma. The patient underwent sclera plastic surgery twice in order to save the eye. Due to intensive corticosteroid and cytostatic therapy clinical activity of vasculitis was reduced. At the same time was observed further growth of nose granoluma with damage of inferior orbital wall and spread of the tumor to the orbital cavity with the subsequent destruction of the eye. It was performed an enucleation of the left eye with removal of the tumor of the left orbit. The Wegener's granulomatosis diagnosis was confirmed histologically. The problem of treating systemic vasculitis and its complications is very relevant. During 5-year observation period the patient there were noted another complications: septal perforation, oroantral fistula formation, formation of bilateral hearing loss, disintegration of the left lung granuloma. Right eye stayed intact during whole observation period. Prognosis is unfavorable not only for eyesight, but also for patient's life. Keywords: Wegener's disease, granulomatosis with polyangiitis, necrotizing sleritis

Mussel adhesive proteins as surgical sealants in post-extraction: Literature review

Background and objective: Tooth extraction is a dental procedure of removing a tooth from its socket, causing an injury. Dental socket wounds that are directlyexposed to the oral environment allow the entry of pathogenic micro-organisms that can cause post-extraction bleeding, alveolar osteitis, oroantral fistula, and others. Recent studies have shown that the use of mussel adhe-sive proteins (MAPs) without sutures or staples can accelerate socket wound closure or stopbleeding after tooth extraction. Con-clusion: MAPs that have been synthesized into injectable citrate-based mussel-inspired bioadhesive have the potential assurgical sealants after tooth extraction because they have strong adhesive properties in wet environments, good esthetics, atraumatic, and short operating time.

Does Subperiosteal Scoring Contribute to Enhanced Success of Rehrmann Flap for Closure of Oro-Antral Fistula?

Does Subperiosteal Scoring Contribute to Enhanced Success of Rehrmann Flap for Closure of Oro-Antral Fistula?

Presence of anaerobic bacteria and symptoms supports diagnosis of odontogenic sinusitis

PurposeThe present study aimed to investigate the diagnostic indicators of odontogenic sinusitis other than computed tomography (CT) findings and the history of dental treatment such as detected bacteria and symptoms. Materials and methodsWe performed a retrospective analysis of 87 patients who underwent surgery for unilateral sinusitis between 2016 and 2020 (n = 87). Patients with cysts and fungal sinusitis were excluded from the study. We analyzed the relationship between the presence/absence of CT findings such as periapical lesions and oroantral fistulas; anaerobic bacteria; and symptoms in patients with unilateral sinusitis. ResultsThere was a significant correlation between the detection of anaerobes and CT findings. Peptostreptococcus sp., Prevotella sp., Streptococcus anginosus group, and Fusobacterium sp. were the most commonly isolated species. Detection of these anaerobic bacteria supports the diagnosis of odontogenic sinusitis. Moreover, ODS often present with symptoms, such as a foul smell and facial pain. ConclusionsOur results suggest that not only the presence of CT findings such as PAL and OAF, but the detection of anaerobic bacteria, and the presence of any symptoms may aid in the diagnosis of ODS.

Diagnosis and Management of oro-antral fistula: Case series and review.

Introduction and importanceThe oro-antral communication (OAC) is a pathological opening between the maxillary sinus and the oral cavity. When it does not close spontaneously or if it is not treated, it remains permeable and epithelializes to develop into an oro-antral fistula (OAF) and can cause maxillary sinusitis.Cases presentationThe authors present through 5 clinical cases the different steps of the surgical protocols opting for the buccal fat pad flap and the advanced buccal flap to treat OAF/OAC.Clinical discussionSurgical closure of the OAC within 48 h is recommended to avoid complications. Several alternative techniques have been described over the years for the management of the OAC and OAF, with their advantages and limitations. The most commonly used surgical flaps are of two types: the advanced buccal flap and the buccal fat pad (BFP) flap.ConclusionThe adequate availability of the advanced buccal flap and the buccal fat pad (BFP) flap in the majority of patients, the easy handling, the minimal donor site morbidity as well as the excellent blood supply make them perfect flaps for the closure of OAF/OAC. However, follow-up remains a key point and very important to avoid complications. The present case series was limited by the small number of patients and the authors recommend a study with larger groups.