We report two cases of persistent oroantral fistula complicating transantral internal maxillary artery ligation. Doublelayered closure of oroantral fistula using buccal fat. Its broad base ensures adequate blood supply and, consequently, high success rate 93% had been reported. Primary closure of a sinus perforation primary closure of a sinus perforation is indicated for large. The buccal mucosa flap is advanced to cover the defect. An unnatural communication between the maxillary sinus and oral cavity is known as oroantral communicationoac and if it does not close spontaneously, it is epithelialized so that oroantral fistula develops. After removal of a dental implant or extraction of a tooth in the upper jaw, the closure of an oroantral fistula oaf or oroantral communication oac can be a difficult problem confronting the dentist and surgeon working in the oral and maxillofacial region. Ramesh babu 2 department of oral and maxillofacial surgery, indira gandhi institute of dental sciences, mahatma gandhi medical college and research institute campus, pillaiyarkuppam. Many surgical techniquesmethods have been proposed to close it.
The healing of the wound and closure of the defect could be seen after a 30day postoperative period, with complete epithelialization. The term oroantral fistula is meant to indicate a canal lined by epithelium that may be filled by granulation tissue or by polyposis of the sinus membrane, most frequently due to iatrogenic oroantral communication. Saleh bakry assistant professor of oral and maxillofacial surgery 2. Its treatment involves removal of the oroantral fistula, surgery of the maxillary sinus and closure of the oroantral defect 1,2,5.
Jun 01, 2012 the term oroantral fistula is meant to indicate a canal lined by epithelium that may be filled by granulation tissue or by polyposis of the sinus membrane, most frequently due to iatrogenic oroantral communication. In the setting of an active sinus infection, concurrent sinus surgery will reduce the risk of recurrence. Oroantral fistula repair with different surgical methods. Evaluation of a new surgical technique for closing oroantral. Surgical anatomy of maxillary sinus note on oroantral. Oroantral fistula oaf is a relatively uncommon complication of maxillary molar extraction. At this point, the zerodegree endoscop was used to visualize the right nasal cavity. Secondary closure of oroantral and oronasal fistulas. This retrospective single center study includes all patients with. Pdf use of collagen for closure of oroantral fistula. Oroantral fistula article about oroantral fistula by the. An oroantral fistula oaf may develop as a complication of dental extractions, as a result of infection, or as sequelae of radiation therapy, trauma, and removal of maxillary cysts or tumors.
Pdf communication between the maxillary sinus and oral cavity is a. Onestage operation of large oroantral fistula closure, sinus lifting, and autogenous bone grafting for dental implant installation. This happens when perforation lasts at least 4872 hours9. It is sutured to the edges of the defect with absorbable sutures. Debride the socket and pack with gelfoam to help form a blood clot. Mar 29, 2016 ubc medicine neurology clinical skills motor, sensory, and reflex examination duration. Suggested by sme walk the moon one foot official video.
We present the modified doublelayered flap technique, which is similar to the treatment of labiopalatoschisis, has a high rate of success that is dependent on the skill of the surgeon, and will involve a steep learning curve. The risks of a closure of an oroantral fistula may include. This oroantral fistula was caused by extraction of the left upper first molar. Then the edges of the fistula were excised and fistula wall was dissected in a stitched layer by three surgical methods. Doublelayered closure of oroantral fistula using buccal fat pad and buccal advancement flap ramesh candamourty, manoj kumar jain, 1 k. Anteriorly based palatal flap for closure of large oroantral fistula oral surg oral med oral pathol oral radiol endod 1996. In 4050 % of maxillary necrosis the maxillary sinus is involved, leading to maxillary sinusitis and oroantral communications. Case report a 28 year old male patient had referred to the department of the oral and maxillofacial surgery, m.
Oroantral fistula is an uncommon complication in oral surgery. Doublelayered closure of oroantral fistula using buccal. To show a case report of oroantral fistula and its closure. Oroantral fistula oaf is an epithelialised oroantral communication oac. Use of double layer technique for closure of oroantral fistula our experience. Summary closure of oroantral fistula may often be a difficult problem presenting a chal lenge to the oral surgeon. A fistula latin a pipe or tube is an abnormal communication between the lumen or surface of one organ and the lumen or surface of another or between vessels. Alternative surgical management of oroantral fistula e341 fig. The adipose tissue of the cheek was used by abuabara et al. Note the opacification of the maxillary sinus, indicating chronic infection. Various surgical options pulkit khandelwal 1, neha hajira 2 abstract 2ur dqwudofrppxqlfdwlrqdqg. Rhinosinusitis associated with postdental extraction.
While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla. Treatment of oroantral fistula jama otolaryngologyhead. Mar 30, 2017 oroantral fistula oaf is considered a frequent complication in dental practice. Oroantral communication followed by oroantral fistula oaf is a rare surgical complication in oral and maxillofacial surgery. The oaf was closed by autotransplantation of upper third molar placed. Oac refers to an abnormal connection between the oral cavity and antrum or maxillary sinus. Extraction maxillary sinus cyst tumor osteomyelitis radiation therapy trauma syphilis implant denture 3. Im mediate repairs of the acute oroantral defect have a uni formly high success rate approaching 95% that decreases to 67% in cases of delayed closure. Recent studies revealed that an oroantral fistula should be closed within. Decisionmaking in closure of oroantral communication and. Oroantral fistula oaf is considered a frequent complication in dental practice. Treatment of oroantral fistula a study mucoperiosteal flap is created and suture over the defect.
Repair oroantral fistula otolaryngology coding ask an expert. Intraoral postoperative appearance of the operation side after six months. Grafting of the pedicled buccal fat pad is thought to be an efficient, safe and easy alternative to a larger oroantral fistula closure. The oaf was closed by autotransplantation of upper third molar. Buccal fat pad, buccal flap, oroantral fistula, oroantral communication introduction an oroantral communication oac may develop as a complication of dental extractions, due to infection, sequelae of radiation therapy, trauma, and removal of maxillary cysts or tumors. The treatment need an approach that presents the capacity to promote closure of the communication or fistula, leading to the recovery of health. Fistula forms because of oral epithelial migration into the fistulous communication. The creation of an oac is most commonly due to the extraction of a maxillary upper tooth typically a maxillary first molar closely related to the antral floor floor of the maxillary sinus. Moreover, any sinus disease must be cured to allow the fistula to close. Repair oroantral fistula otolaryngology coding ask an. Various techniques have been proposed in literature only few have gained wide acceptance.
An important role in the healing process is played by the presence of sinus diseases. Fistula may be closed by using alveolar, palatal or jugal mucosa flaps, after. Closure of oroantral fistula with the septal cartilage. For the closure of oroantral fistula, many techniques have been described.
Several techniques have been used to close oroantral communications, and they vary in their difficulty of execution and success. Closure of oro antral fistula by using a membrane youtube. No nasoantral window was fashioned in either of these cases. Management of oroantral fistula linkedin slideshare. Oral fistula oaf is a pathological communication between the oral cavity and maxillary sinus which has its origin either from iatrogenic complications or from dental infections, osteomyelitis, radiation therapy or trauma. Alternative surgical management of oroantral fistula using. The lateral aspect of the right concha bullosa was removed with the endoscopic shaver. Any information contained in this pdf file is automatically generated from. Many authors have described various surgical techniques, starting with durham in 1893 who advocated vascularised soft tissue pedicle flap for closure of these defects. The clinical practice most frequently involves the monolayer technique of closing an oroantral defect developed. Ubc medicine neurology clinical skills motor, sensory, and reflex examination duration.
This offers a precise diagnosis of siinusal oral sinus communications magnitude and their correct location, making the surgical planning easy for the professional and avoiding complications for the patient. Oroantral communications are caused by odontogenic inflammatory processes, which can cause progressive destruction of either the floor or side of the maxillary sinus, or by iatrogenic manoeuvres such as dental extractions, or even avascular necrosis osteonecrosis as a result of the use of bisphosphonates. Development of an oroantral fistula following sinus elevation surgery. Consider a nasal steroid spray, such as flonase to limit inflammation of the sinus lining. Surgery practice is oroantral fistula, a pathological pathway between the. Jul 20, 2010 for the closure of oroantral fistula, many techniques have been described. Oroantral fistula definition of oroantral fistula by the. Rhinosinusitis associated with postdental extraction chronic.
However in large defects surgical closure is required. Various techniques have been examined for the closure of oroantral. May 21, 2016 surgical closure of oroantral fistula. The aim of this study was to evaluate the autotransplantation of upper third molar for closing oaf. Treatment of oroantral fistula acta stomat croat 2002. This complication can occur in any location from the upper canines, caudally. The management of bisphosphonate related necrosis of the jaw has become clinical routine. We present a technique in which nasoseptal cartilage graft is used for the closure of the oroantral communication. A coronal ct scan of the sinuses, showed a defect in the floor of the left maxillary antrum, corresponding to the oroantral fistula.
A rotational flap of the buccal mucosa was then elevated with the bovieelectrocautery device. After excising the fistula, the mucosa of the two minor flaps of the htype windowlike incision figures 7b and 10 was elevated and separated from the underlying connective tissue without jeopardizing the continuity of the mucosal flap figure 9. The three groups were compared concerning the success or failure of surgical technique based on complete closure of oaf after three months postoperatively. Oroantral fistula definition of oroantral fistula by. We harvested a sliding palatine flap at partial thickness. The right osteomeatal complex was then opened with a. Oroantral communication closure using a pedicled buccal fat. The incidence of oroantral fistula following imax ligation is very low but those cases reported have been associated with the failure to create a nasoantral drainage window. The oroantral fistula is a pathological connection between the maxillary sinus and with the. Mar 19, 20 use overthecounter sympathomimetics, such as otrivin or sudafed to control sinus congestion for a maximum of 3 days. Use overthecounter sympathomimetics, such as otrivin or sudafed to control sinus congestion for a maximum of 3 days. Treatment of oroantral fistula with autologous bone graft and. We recovered the oroantral communication using the sliding flap, without suture in.
An oroantral fistula can occur as the consequence of a postoperative acute sinusitis or of a sinusal mucosa perforation sequent to implants placement6,7,8. Oro antral fistula it is an abnormal epithelized communication between maxillary sinus and oral cavity through perforation in the sinus wall 3. Oaf closures can be achieved using different flaps. Oroantral communication closure using a pedicled buccal. After six weeks, if the onf is large enough to cause chronic rhinitis and sneezing, closure by. The bony fragment itself was then debrided back to healthy bleeding tissue. A 6monthsurgical treatment of oroantral fistula, after a tooth removal, using the buccal.
Modified doublelayered flap technique for closure of an. Sixmonth postoperative panoramic radiograph showing the defect filled new bone. Evaluation of a new surgical technique for closing. Surgical options in oroantral fistula treatment fulltext. The treatment proposed to the patient was closure of the oroantral fistula using palatine flap. A preliminary study of monocortical bone grafts for oroantral fistula closure. Although smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always require surgical closures. An oroantral fistula will not heal spontaneously and must be surgically repaired.
Shivani sachdeva abstract various options are available for the surgical management of oroantral fistulae however postoperative wound. There are advantages and disadvantages of all these techniques. Treatment of oroantral fistula with autologous bone graft. In general, most patients will have spontaneous closure of a small oroantral fistula oroantral fistula oaf is an epithelialised oroantral communication oac. Meticulous planning is employed to maximize the successful closure of an oroantral fistula. Decisionmaking in closure of oroantral communication and fistula. Use of double layer technique for closure of oroantral fistulaour experience. It is the intention of this article to discuss the problems in the treatment of oroantral fistulas and to represent an operation for their closure that has not received the recognition it deserves. In cases of healthy antrum and small fistula, closure is usually spontaneous.
Large, chronic, functional oral nasal fistula at site of 104. Wound dehiscence and persistent fistula is common complication following isolated local flaps, the article oroantral fistula using buccal fat pad and. Alternative method to treat oroantral communication and. Oro antral communication oro antral fistula classification. Use of double layer technique for closure of oroantral.
Closure of oroantral communications using a pedicled buccal fat pad graft. The closure of oroantral fistula can yet be done through the use of monocortical bone grafts or tooth transplant. Closure of oroantral fistula is still one of the most challenging problems in the field of oral surgery. Furthermore, improper treatment of oac can produce maxillary sinusitis and become chronic 8. Ubc medicine educational media recommended for you. Through the fistula itself, a marked amount of thickened mucosa was stripped out and removed. Rhinosinusitis associated with postdental extraction chronic oroantral fistula. Closure of oroantral fistula with the septal cartilage graft. Without treatment, fistula often leads to chronic oafs, which usually. Surgical anatomy of maxillary sinus note on oroantral fistula. Twenty patients participated in this study aged between 20 and 40 years old.