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

Oroantral Communications: Clinical Efficacy of a Double-layered Technique With/Without the Palatal Connective Tissue Flap: A Superiority, Single-center, University-based Randomized Clinical Trial

The aim of this study was to compare the clinical results of combining a pedicle connective palatal flap coupled with the trapezoid buccal flap against the buccal flap alone in the closure of the oroantral fistula. Individuals with oroantral communication were consecutively included and eventually randomly allocated into 2 groups. In the group test, oroantral fistula was treated with the association of a buccal flap with a pedicle palatal connective tissue flap; in group control, a classic buccal sliding flap was performed. Patients' outcomes were recorded at 48 hours, 1 week, 2 weeks, and 1 month after surgery for assessment of primary (success rate) and secondary endpoints, such as experienced pain, discomfort, and complications. The success rate was 96.6% for the test group and 86.6% for the control group. No significant difference between the 2 groups could be observed regarding discomfort and pain. More pronounced pain was detected in the test group during the early healing period. This surgical procedure was demonstrated to be successful, with a high success rate and low patient discomfort.

Successful Closure of an Oro-Antral Communication, after Three Previously Failed Attempts, Using Bichat Fat Pad Flap: A Case Report

An oro-antral communication represents an abnormal connection between the oral cavity and the maxillary sinus. It occurs most often after tooth extractions, improper implant placement or incorrect management of the sinus lifts. Surgical repair is challenging and most practitioners usually choose the buccal advancement flap, the palatal flap and in some cases the buccal fat pad flap to close the defect. We present a 43 year-old female of a large oro-antral communication and associated chronic sinusitis which was succesfully manged by surgery. Previous interventions including 2 buccal advancement flaps, and a double layer closure using Collagen membrane and buccal advancement flap were unsuccesful. The stepwise intervention consisted on the complete cleaning of the sinus, using the Caldwell Luc technique, followed by the closure of the oro-antral communication using Bichat fat pad flap. The particular aspect was the proper integration of the buccal fat pad flap, after 3 failed attempts, without dehiscence or any other complications. The buccal fat pad flap can be succesfully used for closure of lage oro-antral communications, even when previous methods have failed and local tissue is of poor quality.

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications

INTRODUCTION

an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large defects and underlying general conditions. Bichat fad pad flap is a multipotent pedicled fatty tissue that is easily accessible from the oral cavity that can be used for the closure of medium-sized defects, even in immunocompromised patients due to its stem cell capacity.

MATERIALS AND METHODS

the medical information of the patients diagnosed with oro-antral communications who were admitted and treated in the Oral and Maxillo-Facial Clinic Targu Mures, between 2013 and 2020 were analyzed. A database containing general information, reported causes, associated diseases, surgical methods used during admission, and relapses, was created. The information was statistically processed. The written consent and ethical approval were obtained.

RESULTS

the study shows that from a total of 140 cases, 72 were treated using buccal advancement flap, 49 using Bichat fat pad flap, and 19 using palatal flaps. The dimensions of the communications ranged between 0.3 cm and 1.5 cm. Several statistically significant results could be found when comparing the surgical methods. Of the 72 patients treated with buccal advancement flaps, 25 presented relapses as opposed to the patients treated with Bichat fat pad flaps who showed no complications, p < 0.05. Analysing this aspect further, all large defects (10 cases) ranging from 0.6 cm to 1.5 cm treated with advancement buccal flaps (Rehrmann flaps) showed relapses (p < 0.05). Considering the general conditions, out of 7 patients who received radiotherapy 4 presented relapses, as opposed to the healthy patients, p < 0.05. Regarding the reintervention for the relapsed cases, the majority of the cases treated a second time with buccal advancement flap (5 out of 7 cases) failed as opposed to the Bichat fat pad flap with no further relapses (p < 0.05).

CONCLUSIONS

the most frequently used surgical treatment is the buccal flap, which also has the highest relapse rate. Both primary treatment with Bichat fat-pad flap and re-treatment of relapses using this flap have had 100% success rates, even in patients with general associated conditions, in contrast with patients treated by using the buccal flap. The dimensions of the oro-antral communication and general conditions are crucial factors for the success of the surgical treatment.

A Double Barrier Technique in Surgical Closure of Oroantral Communication

Routine minor surgical procedures in the maxillary premolar or molar region often heal without any repercussions; however, some may culminate in an unintentional opening into the maxillary sinus, leading to the formation of oroantral communication. It is, therefore, imperative for a surgeon to recognize it and treat it sequentially to avoid long-term complications. This case report highlights a flapless double membrane closure of oroantral communication (OAC) with platelet-rich fibrin (PRF) and guided tissue regeneration (GTR) membranes and its edge over conventional methods.