B circular incision around the fistula and mucosa displacement on the fistulous path. The oac is often confused with the oroantral fistula oaf which is defined as a persistent epithelialized open communication. It is the purpose, therefore, of this paper to outline those modern measures which have proved most successful in the treatment of this condition. Various surgical options pulkit khandelwal 1, neha hajira 2 abstract 2ur dqwudofrppxqlfdwlrqdqg. The treatment of oroantral communications should be performed immediately when the opening is created or later in cases of failure of primary closure schow9. Oroantral fistula oaf is an epithelialized communication between the oral cavity and the maxillary sinus. Case series abstract oroantral fistula oroantral communications oacs is a pathological communication between the oral cavity and the maxillary sinus which has its origin either from dental infections, trauma, radiation therapy, or osteomyelitis.
Infection, cysts or other pathology will weakens the bone around the roots of teeth may make an opening more likely to occur. Unusual etiology and diagnosis of oroantral communication due. Oroantral fistula definition of oroantral fistula by. Openings smaller than 2 mm may heal spontaneously, whereas larger openings require surgical treatment. The purpose of the present study was to report three cases of oroantral fistula with specific treatment propositions, contributing to the information of professionals about appropriate. Saleh bakry assistant professor of oral and maxillofacial surgery 2. Jul 09, 2018 an oroantral perforation is an unnatural communication between the oral cavity and maxillary sinus. Development of an oroantral fistula following sinus elevation surgery. The case was send it to us in order to repair and to build a. A late buccosinusal fistula in the 1516 tooth area.
The oroantral fistula oaf develops if the oac remains open and becomes epithelialized. Oro antral fistula it is an abnormal epithelized communication between maxillary sinus and oral cavity through perforation in the sinus wall 3. The treatment need an approach that presents the capacity to promote closure of the communication or fistula, leading to the recovery of health. Oroantral fistula is a communication between maxillary sinus and oral cavity, dental diseases has been reported recently in 30% of maxillary sinusitis cases, the. Treatment of oroantral fistula jama otolaryngologyhead. Upon clinical examination, an approximately 10mm fistula was observed connecting the oral cavity to the maxillary sinus.
Surgical options in oroantral fistula treatment ncbi. Note the opacification of the maxillary sinus, indicating chronic infection. Jun 01, 2012 treatment modalities to repair the oroantral fistula include local or free soft tissue flaps, with or without autogenous grafts or alloplastic implants. The primary purpose is to close the communication and prevent sinusitis. Herein, we present a case of oroantral communication that was to be treated with clinical examination, tomography, and prototyping. The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. Its broad base ensures adequate blood supply and, consequently, high success rate 93% had been reported. 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. The practicing oral and maxillofacial surgeon treating patients with oroantral communication oacoroantral fistulas should be familiar and competent with the various treatment options available. Secondary closure of oroantral and oronasal fistulas. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Adele scattarella 1, andrea ballini 1, felice roberto grassi 1, andrea carbonara 1, francesco ciccolella 1, angela dituri 1, gianna maria nardi 2, stefania cantore 1, francesco pettini 1. In addition to 262 articles on the closure of oroantral, 4 articles on the closure of antrooral fistula in humans, and 5 articles in animals, citations were referenced to identify further relevant.
Oroantral fistula an overview sciencedirect topics. Pdf surgical options in oroantral fistula treatment. Review open access surgical options in oroantral fistula management. There was no discharge from the fistula or any signs of acute infection. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oroantral communication.
Modern management of oroantral fistula jama otolaryngology. The management of bisphosphonate related necrosis of the jaw has become clinical routine. Material and methods in the past four years i have treated 41 patients with oroantral fistulas. An outpatient surgical procedure was performed with the use of local anesthetics to close the oroantral fistula with a rotating pedicled buccal fat pad flap. Oroantral communication oac acts as a pathological pathway for bacteria and can cause infection of the antrum, which further. Oroantral, fistula, flaps, grafts, maxillary sinus, complication management, oral surgery, decision, oroantral communication. The oroantral fistula has its origin either from iatrogenic complications or from dental infections, trauma, radiation therapy, or osteomyelitis. Clinical figure 1 and radiographic investigation figure 2 revealed oroantral communication in the vestibular ridge. Various surgical methods and approaches have been described in the literature for the treatment of oroantral fistulas and each of them has its specific. Oroantral fistula article about oroantral fistula by the. Oroantral communication is a pathological communication between the oral and antral cavities. This retrospective single center study includes all patients with. Alternative method to treat oroantral communication and fistula with. Often neither the patient nor the dentist will be aware of the hole.
Treatment of oroantral fistula with autologous bone graft and application of a nonreabsorbable membrane. The oroantral fistula was deepithelialized under local anaesthesia and the patient wore a surgical splint continuously, removing it only for cleaning, for an eight week period. An oroantral perforation is an unnatural communication between the oral cavity and maxillary sinus. A coronal ct scan of the sinuses, showed a defect in the floor of the left maxillary antrum, corresponding to the oroantral fistula. Oroantral fistula oaf is an epithelialised oroantral communication oac. Of these 12 had socalled acute fistulas and 29 had chronic fistulas. A new surgical management for oroantral communication.
Oroantral fistulae may develop postoperatively, especially if the patient has a history of past sinus pathology or infection. Treatment of oroantral fistula a study mucoperiosteal flap is created and suture over the defect. The operated case had no complications and the oroantral communication was cured. Oroantral communication followed by oroantral fistula oaf is a rare surgical complication in oral and maxillofacial surgery. Four month a go a sinus lift was performed and an oroantral communication and fistula was created. Treatment of chronic oroantral fistula with plateletrich. The case was send it to us in order to repair and to build a new condition for the implant placement. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. It is the purpose, therefore, of this paper to outline those modern. Closure of oroantral communication using buccal advancement. Oroantral communication closure using a pedicled buccal. May 25, 2015 four month a go a sinus lift was performed and an oroantral communication and fistula was created.
Management of oroantral communication using buccal advanced flap. The oroantral fistula oaf is a pathological communication between the oral cavity and the maxillary sinus. The term oroantral fistula is similar to but not synonymous with the term oroantral communication oac. Jan bellows surgical treatment before surgery, a complete oral examination eg, toothbytooth assessment with periodontal probe, fullmouth intraoral radiography must be performed while the patient is under general anesthesia. Other causes of perforation into sinus include destruction of a portion of the sinus following facial bone fractures, periapical lesions, removal of large cystic cavity that encroach on sinus cavity and in cleft patients. Many chronic oroantral fistulas treated in the past could have been prevented had certain steps been taken immediately after their occurrence.
Acute oroantral fistula extraction of one of the upper molar teeth is the usual cause of acute oroantral fistulas. When oroantral communication is left open, epithelial tissue may develop namely oroantral fistula. Treatment of oroantral fistula with autologous bone graft and application of nonresorbable. Oaf closures can be achieved using different flaps which show both advantages and limitations. Decisionmaking in closure of oroantral communication and. Small openings are very common and will usually heal by themselves with no treatment. 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. While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla.
Carefully follow the patient after 12 weeks and advise to avoid straining the area no holding back sneezes, no smoking, no use of straws, no pressure on the sinus. Treatment of chronic oroantral fistula with plateletrich fibrin clot and collagen membrane. Oroantral communication oac is a pathological connection between the oral cavity and the maxillary sinus due to loss of soft and hard tissues that normally separated these compartments. An oroantral fistula will not heal spontaneously and must be surgically repaired. Small oroantral fistulae treatment with systemic antibiotic drugs and daily rinses with chlorhexidine. Decisionmaking in closure of oroantral communication and fistula. If the initial treatment of an oroantral perforation fails and fistula formation occurs, the treatment of the oroantral fistula may require the combination of medical and surgical interventions. Although various techniques have been proposed in published studies, longterm successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon. Oroantral fistula oaf is an abnormal condition that manifests a pathological communication between the maxillary sinus and the oral cavity. Oroantral communication is the consequence of a loss of continuity between the maxillary sinus and the oral cavity. Pdf communication between the maxillary sinus and oral cavity is a common complication in oral surgery. No treatment required as it will usually naturally heal. An oroantral communication oac is an open con nection between the oral. The open dentistry journal, 2012, 6, 9498 94 1874210610 2010 bentham open open access surgical options in oroantral fistula treatment andrea enrico borgonovo1, frederick valerio berardinelli2, marco favale2 and carlo maiorana3 1school of oral surgery, university of milan, italy 2department of oral surgery dental clinic, fondazione irccs ca granda ospedale maggiore policlinico, milan.
Case of oroantral communication closure using a pedicled buccal fat pad graft. Unilateral odontogenic sinus infection is treated and cured by drainage and removal of the odontogenic cause. Nonsurgical management of an oroantral fistula in a. A patient presented with oroantral communication with purulent exudation for 4 months, since the displacement of the dental implant and oring component to the maxillary sinus.
Treatment modalities to repair the oroantral fistula include local or free soft tissue flaps, with or without autogenous grafts or alloplastic implants. Pdf closure of oroantral fistula by using buccal fat pad or. The fundamentals of treatment of acute oroantral fistulas include 1 adequate antimicrobial therapy, preferably penicillin. Management of oroantral fistula linkedin slideshare. Samir gendy consultant ent surgeon, emersons green nhs treatment centre, uk. The fistula is established for migration of the oral epithelium in the communication, event that happens when the perforation lasts from at least 4872 hours. An oroantral fistula is an epithelialized, pathological, unnatural communication between these two cavities. C absorbable 40 catgut suture on the right maxillary sinus mucosa. Oac refers to an abnormal connection between the oral cavity and antrum or maxillary sinus. Surgical options in oroantral fistula treatment article pdf available in the open dentistry journal 61. Oaf mostly results from insufficient knowledge and preparation before dental. Adele scattarella, andrea ballini, felice roberto grassi, andrea carbonara, francesco ciccolella, angela dituri, gianna maria nardi, stefania cantore, francesco pettini. May 21, 2016 oroantral fistula oaf is a relatively uncommon complication of maxillary molar extraction. Comparative study, authorahmad al nashar and hasan m.
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. Treatment of oroantral communication using the lateral. Oral fistula oaf is a pathological communication between the oral cavity and maxillary sinus which has its origin either from. In 4050 % of maxillary necrosis the maxillary sinus is involved, leading to maxillary sinusitis and oroantral communications. An oroantral fistula refers to an epithelialized pathological unnatural communication between the oral cavity and the maxillary sinus. The diagnosis was established using the nose blowing test and probing introduction of a silver probe into the antrum through the fistula. Surgical options in oroantral fistula treatment europe pmc. Clinical decisionmaking determines the optimal strategy in a particular clinical situation. 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.
Primary closure of a sinus perforation primary closure of a sinus perforation is indicated for large. Treatment of oroantral fistula a study introduction oroantral communication followed by oroantral fistula oaf is a rare surgical complication in oral and maxillofacial surgery. Closure of oroantral fistula by using buccal fat pad or buccal advancement flap. Treatment plan has been explained to the patient, and preoperative medications were advised. Treatment of oroantral fistula with autologous bone graft. Technical choice of professionals for the closure of oroantral fistula can be influenced by the clinical aspects of each defect location and size, further prosthetic treatment, and experience of surgeons.
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