Application of the interseptal alveolotomy for closing the oroantral fistula

Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital

Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin (CMSDO) requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with a combined surgical approach for CMSDO due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after the primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.

Surgical options in oroantral fistula management: a narrative review

An oroantral fistula (OAF) is a pathological abnormal communication between the oral cavity and the maxillary sinus which may arise as a result of failure of primary healing of an OAF, dental infections, osteomyelitis, radiation therapy, trauma, or iatrogenic complications. With the presence of a fistula, the maxillary sinus is permanently open. Microbial flora passes from the oral cavity into the maxillary sinus, and the inflammation of the sinus occurs with all potential consequences. In literature, various techniques have been proposed for closure of OAFs. Due to the heterogeneity of the data and techniques found, we opted for a narrative review to highlight the variety of techniques discussed in the literature. Techniques of particular interest include the bone sandwich with resorbable guided tissue regeneration (GTR) membrane and platelet-rich fibrin (PRF) used alone as both a clot and a membrane. The great advantage of these techniques is that no donor site surgery is necessary, making the outcome valuable in terms of time savings, cost and, more importantly, less discomfort to the patient. Additionally, both bony and soft tissue closure is performed for OAF, in contrast to flaps, which are typically used for procedures in the sinus area. The reconstructed bony tissue regenerated from these techniques will also be appropriate for endosseous dental implantation.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

Evaluation of a New Surgical Technique for Closing Oroantral Fistula Using Auto-transplanted Upper Third Molar: A 1-Year Follow-Up Study

Background

Oroantral fistula (OAF) is considered a frequent complication in dental practice. Many surgical techniques/methods have been proposed to close it. The aim of this study was to evaluate the auto-transplantation of upper third molar for closing OAF.

Materials and Methods

Twenty patients participated in this study aged between 20 and 40 years old. The OAF was closed by auto-transplantation of upper third molar placed directly in the socket of the extracted tooth. Results were evaluated clinically and radiographically through the period of observation which lasted for 1 year.

Results

Final results showed that the success rate of closing OAF was 95% while the success rate of upper third molar auto-transplantation was 90%.

Conclusion

This technique is simple, applicable, provides immediate replacement of the missing tooth, and does not require complicated instruments or procedures.

Closure of oroantral fistula using titanium plate with transalveolar wiring

BACKGROUND

Alloplastic materials such as tantalum, gold plates and foils, hydroxyapatite blocks have been used for closure of oroantral fistula (OAF). However, these materials are not widely accepted in routine surgical closure of OAF due to cost, difficult handling, increased rate of infection, and exfoliation.

PURPOSE

To overcome the above drawbacks this study aimed to use titanium plates (0.3 mm) with transalveolar wiring fixation for closure of OAF.

PATIENTS AND METHODS

Ten patients with OAFs who consented to undergo this trial were selected and treated under an outpatient basis in the Oral Surgery Department, Faculty of Dentistry, Mansoura University, Egypt.

RESULTS

All OAFs were successfully treated with no eventful complications.

CONCLUSION

This study concludes that titanium plates with transalveolar wiring fixation is an excellent technique for closure of OAF. The high success rate with this technique warrants its use for closure of OAF.

Surgical treatment of oroantral fistulas: a clinical study of 23 cases

Oroantral communication can be defined as a pathologic space created between the maxillary sinus and the oral cavity. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region. The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula, and, even, the surgeon's past experience. In the present study, 23 patients with a chronic oroantral fistula who underwent surgical correction at Istanbul University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery from 2002 to 2009 were included. The fistulas were treated with a buccal advancement flap in 10 patients and a palatal island flap in 13 patients. The advantages, limitations, and complications of each technique are discussed.

Simultaneous oral antral fistula closure and sinus floor augmentation to facilitate dental implant placement or orthodontics

Several techniques have been used to treat the oroantral fistula with similar rates of success and failure. Some of them frequently present anatomical disadvantages. They can reduce vestibular depth, cause lack of support bone, or cause fusion of the Schneiderian and mucosal membranes. In this report, we present 3 cases of orosinusal fistulas successfully treated with a simultaneous closure of the communication and sinus floor augmentation. At the same time, this technique enables the restoration of the alveolar process with enough bone volume, which facilitates later implant surgery, prosthetic rehabilitation, or even some orthodontic treatments.

Bony press-fit closure of oro-antral fistulas: a technique for pre-sinus lift repair and secondary closure

PURPOSE

To evaluate the use of intra-oral bone grafts for closing chronic oro-antral fistulas (OAFs), for providing a sound basis for subsequent conventional sinus lifting and for preserving the teeth adjacent to OAFs.

PATIENTS AND METHODS

Twenty-one patients with oro-antral fistulas of variable origin were treated with monocortical bone blocks harvested from the retromolar or interforaminal regions of the mandible. The preoperative treatment, the surgical procedure for both hard and soft tissue closure, and the postoperative management are reviewed in detail.

RESULTS

Press-fit closure for repair of the bony sinus floor was sufficient in 17 patients. Four of them needed additional internal fixation. In all 21 patients adequate closure of the fistulas was obtained, although 3 patients (14.3%) developed wound dehiscences at the grafted sites, which healed by secondary intention. Meanwhile, 3 patients underwent successful sinus lifting.

CONCLUSION

The use of monocortical bone grafts harvested at intra-oral donor sites is a safe and easy technique for repairing defects of the maxilla, especially OAFs in need of secondary closure. It provides a sound basis for subsequent conventional sinus lifting and preserves the teeth adjacent to OAFs.

Evaluation of different treatments for oroantral/oronasal communications: experience of 112 cases

This retrospective study analyzed the etiologic factors, location and treatments for patients with oroantral or oronasal communications (OAC or ONC). Data analysis extended to gender, age, etiology, location, type of treatment and short-term complications from January 1988 to May 2004. A total of 112 patients with 101 (90%) OAC and 11 (10%) ONC were included. The main etiology for OAC was tooth extraction (95%) with similar prevalence between right (49%) and left (51%) side. For ONC, pathological conditions (27%) and exodontia (27%) were the most prevalent. For the treatment of OAC, suture was the technique most frequently used (60%), followed by buccal fat pad (28%), buccal flap (9%), palatal flap (2%) and one dental transplant (1%). For ONC, the following treatments were used: suture (46%), buccal flap (36%) and palatal flap (18%). Failure to eliminate the communication occurred in six (6%) patients of the OAC group and three (27%) of the ONC group. The results confirm that tooth extraction was the most common etiologic factor for ONC and OAC. Suture, when the communication was small (3-5 mm), and the use of a buccal fat pad (100% successful), when a larger communication existed (>5 mm), seemed to be the two best choices for treatment.

Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases

OBJECTIVE

To review our 17-year clinical experience with delayed oroantral fistula repair by palatal rotation-advancement flap, and to report its advantages, disadvantages, and complications.

STUDY DESIGN

The records of 63 patients with late oroantral fistula treated by palatal rotation-advancement flap from 1984 to 2002 were reviewed. Eleven had undergone unsuccessful closure with a buccal flap. Data recorded were patient age and sex, cause of fistula, signs and symptoms, interval from appearance of fistula to repair, fistula size, radiographic appearance, method of repair, and immediate and late complications.

RESULTS

There were 35 women and 28 men aged 21 to 71 years (mean 50.3 years). Surgery was performed 3 months to 20 years after injury (mean 1.8 years). Twenty-four patients had acute maxillary sinusitis and 39 had chronic sinusitis. The main causes of oroantral fistula were extraction of the second and first molars and pathological lesions within the sinus. Average fistula size was 2.3 cm x 1.6 cm. Fifty-one repairs were preceded by Caldwell-Luc operation. All fistulas were successfully closed with the palatal rotation-advancement flap, with minimal complications on long-term follow-up.

CONCLUSION

The palatal rotation-advancement flap is recommended for the late repair of oroantral fistula owing to its good vascularization, excellent thickness and tissue bulk, and easy accessibility; it also allows for the maintenance of the vestibular-sulcus depth. It is particularly indicated in cases of unsuccessful buccal flap closure.