It results mainly from maxillary premolar and molar extractions when the sinus floor is close to the tooth apex. It can also occur after an infection involving the maxillary teeth, invasion of the sinus cavity by a cyst or carcinoma, trauma, the caldwellluc operation, or other dentoalveolar or. While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla. We recovered the oroantral communication using the sliding flap, without suture in both plans figures 3b and 3c. It leaves an area of exposed bone at the anterior incision of the flap. 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 bony fragment itself was then debrided back to healthy bleeding tissue. Twenty patients participated in this study aged between 20 and 40 years old. 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. Anteriorly based palatal flap for closure of large oroantral. To show a case report of oroantral fistula and its closure. In general, most patients will have spontaneous closure of a small oroantral fistula oroantral oromaxillary fistulas will close spontaneously without any additional intervention. The treatment proposed to the patient was closure of the oroantral fistula using palatine flap. Oroantral communication closure using a pedicled buccal fat. Evaluation of a new surgical technique for closing. They are therefore first seen by the dentist, although the rhinologist may be consulted to help care for the sinus complication.
A coronal ct scan of the sinuses, showed a defect in the floor of the left maxillary antrum, corresponding to the oroantral fistula. Alternative method to treat oroantral communication and. Acrylic surgical splint constructed to cover the oroantral fistula. Oroantral fistula is an epithelialised oroantral communication. Oaf closures can be achieved using different flaps which show both advantages and limitations.
Hence, we present a 50yearold female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features. Oroantral fistula definition of oroantral fistula by. The management of bisphosphonate related necrosis of the jaw has become clinical routine. Fistula forms because of oral epithelial migration into the fistulous communication. Mucoperiosteum of the posterior third of the hard palate, which is more yielding, is raised to bridge large defects without leaving any considerable exposed raw area. Through the fistula itself, a marked amount of thickened mucosa was stripped out and removed. Mar 19, 20 use overthecounter sympathomimetics, such as otrivin or sudafed to control sinus congestion for a maximum of 3 days. 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. This happens when perforation lasts at least 4872 hours9. Here you can read posts from all over the web from people who wrote about fistula and oroantral fistula, and check the relations between fistula and oroantral fistula. The code is valid for the year 2020 for the submission of hipaacovered transactions. 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. For the closure of oroantral fistula, many techniques have been described. Its broad base ensures adequate blood supply and, consequently, high success rate 93% had been reported.
The oroantral fistula oaf is the condition which makes shivers run up and down a dentists spine the condition almost commonly occurs following a complicated upper tooth extraction, when a fistulous communication develops between the oral cavity and maxillary antrum sinus. Odontogenic sinusitis is likely to be underreported in literature. Oroantral communication followed by oroantral fistula oaf is a rare surgical complication in oral and maxillofacial surgery. An unnatural communication between the maxillary sinus and oral cavity is known as oroantral communication. Surgical options in oroantral fistula treatment article pdf available in the open dentistry journal 61. Oroantral fistula oaf is a relatively uncommon complication of maxillary molar extraction.
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. Closure of oroantral fistula with the septal cartilage graft. Oro nasal refers to a communication between the oral and nasal cavity most commonly at the site of the maxillary canine. The case was send it to us in order to repair and to build a new condition for the implant placement. Pdf surgical options in oroantral fistula treatment. The treatment for an oroantral fistula depends on the patients presentation. 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 fistula with autologous bone graft and. Note the opacification of the maxillary sinus, indicating chronic infection. Nonsurgical management of an oroantral fistula in a. The closure of oroantral fistula can yet be done through the use of monocortical bone grafts or tooth transplant. In patients with a persistent communication between the mouth and the sinus that is symptomatic foul tasting discharge, reflux of air or food into the sinus, or development of a sinus infection, surgical repair is indicated to close the fistula. Saleh bakry assistant professor of oral and maxillofacial surgery 2.
Although, dentoalveolar, oroantral, oronasal, and orocutaneous fistulae are the most frequent types related to the oral cavity, an oral fistula may vary depending on the origin. Oroantral fistula is an uncommon complication in oral surgery. Orthopantomograph of the dentition at the time of the initial examination illustrating the state of the remaining alveolus. Intraoral postoperative appearance of the operation side after six months. Decisionmaking in closure of oroantral communication and.
This complication can occur in any location from the upper canines, caudally. Oroantral communication and fistula linkedin slideshare. The adipose tissue of the cheek was used by abuabara et al. 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. Use of double layer technique for closure of oroantral. A technique for closure of large oroantral fistula as a lateral transposition flap with an anteriorly based palatal flap is described. Oac refers to an abnormal connection between the oral cavity and antrum or maxillary sinus. The healing of the wound and closure of the defect could be seen after a 30day postoperative period, with complete epithelialization. Here you can read posts from all over the web from people who wrote about oroantral fistula and swelling, and check the relations between oroantral fistula and swelling. Use of double layer technique for closure of oroantral fistulaour experience. Jul 20, 2010 for the closure of oroantral fistula, many techniques have been described. Oro antral fistula it is an abnormal epithelized communication between maxillary sinus and oral cavity through perforation in the sinus wall 3.
It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. 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. Various surgical options pulkit khandelwal 1, neha hajira 2 abstract 2ur dqwudofrppxqlfdwlrqdqg. Repair oroantral fistula otolaryngology coding ask an expert. A mucoperiosteal flap slides distally a distance of one tooth for closure of an oroantral fistula. Oac is an uncommon complication in oral surgery and. Communication between the maxillary sinus and oral cavity is a common complication in oral surgery. Al though smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always require surgical closures. A 6monthsurgical treatment of oroantral fistula, after a tooth removal, using the buccal. Alternative surgical management of oroantral fistula e341 fig.
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. Shivani sachdeva abstract various options are available for the surgical management of oroantral fistulae however postoperative wound. Various techniques have been examined for the closure of oroantral communications. The oroantral fistula oaf develops if the oac remains open and becomes epithelialized. Oral fistula oaf is a pathological communication between the oral cavity and maxillary sinus which has its origin either from. The oaf was closed by autotransplantation of upper third molar. Surgical anatomy of maxillary sinus note on oroantral fistula. Many surgical techniquesmethods have been proposed to close it.
Oaf could be caused by dental infection, osteomyelitis, radiation therapy, trauma or following removal of maxillary cysts or tumors. Management of oroantral fistula linkedin slideshare. This retrospective single center study includes all patients with. Oroantral fistula definition of oroantral fistula by the. The clinical practice most frequently involves the monolayer technique of closing an oroantral defect developed. Oroantral communication oac acts as a pathological pathway for bacteria and can cause infection of the antrum, which further obstructs the healing process as it is an unnatural communication between the oral cavity and the maxillary sinus. C absorbable 40 catgut suture on the right maxillary sinus mucosa.
Surgery practice is oroantral fistula, a pathological pathway between the. 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. Abnormal connection between the oral and antral cavities. We harvested a sliding palatine flap at partial thickness. 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. Doublelayered closure of oroantral fistula using buccal. Treatment of oroantral fistula a study mucoperiosteal flap is created and suture over the defect. 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. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Grafting of the pedicled buccal fat pad is thought to be an efficient, safe and easy. May 25, 2015 four month a go a sinus lift was performed and an oroantral communication and fistula was created. Case of oroantral communication closure using a pedicled buccal fat pad graft. The oaf was closed by autotransplantation of upper third molar placed.
We present a technique in which nasoseptal cartilage graft is used for the closure of the oroantral communication. Oroantral fistula oaf is considered a frequent complication in dental practice. Reliability of two surgical methods for oroantral communication. The study involved 20 patients and in both groups of patients there was a complete closure of oroantral fistula 1 month post surgery 14, 15. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Use overthecounter sympathomimetics, such as otrivin or sudafed to control sinus congestion for a maximum of 3 days. A small oac may heal spontaneously but a larger oac would require surgical closure to prevent the development of persistent oaf and chronic sinusitis. There are advantages and disadvantages of all these techniques.
In general, most patients will have spontaneous closure of a small oroantral fistula large, chronic, functional oral nasal fistula at site of 104. Actinomycotic osteomyelitis of maxilla presenting as. An oroantral fistula present at the site of the upper left first molar. Martensson reported a sinusitis rate of 50% by the third day after oacs occured. Acute oroantral fistula extraction of one of the upper molar teeth is the usual cause of acute oroantral fistulas. The term oroantral fistula is used to indicate a canal lined by epithelium that may be filled with granulation tissue or polyposis of the sinus membrane. Evaluation of a new surgical technique for closing oroantral. Causes extraction of maxillary posterior teeth most common. Removal of maxillary molars may occasionally results in oro antral communication. Treatment of oroantral fistula with autologous bone graft and application of a nonreabsorbable membrane. Consequently, determining the source of the fistula is the first step in treatment, which must be directed primarily to the underlying cause. Consider a nasal steroid spray, such as flonase to limit inflammation of the sinus lining. Doublelayered closure of oroantral fistula using buccal fat.
Oac refers to an abnormal connection between the oral cavity and antrum. They can arise as late sequelae from perforation and last at least 4872 h. In all cases, tooth extraction was the only etiologic factor. This paper reports the procedure used to close a late oroantral fistula using rotating flaps of the pedicled buccal fat pad. Oroantral fistula american journal of diagnostic imaging. The oroantral fistula is a pathological connection between the maxillary sinus and with the oral cavity. Decisionmaking in closure of oroantral communication and fistula. Oroantral fistula article about oroantral fistula by the. Closure of oroantral fistula with the septal cartilage. Sixmonth postoperative panoramic radiograph showing the defect filled new bone. We recovered the oroantral communication using the sliding flap, without suture in. An oroantral fistula oaf can be defined as an epithelialized pathological unnatural communication between the oral cavity and the maxillary sinus. B circular incision around the fistula and mucosa displacement on the fistulous path.
Its treatment involves removal of the oroantral fistula, surgery of the maxillary sinus and closure of the oroantral defect 1,2,5. Alternative surgical management of oroantral fistula using. Mar 30, 2017 oroantral fistula oaf is considered a frequent complication in dental practice. A small fragment of amalgam is noted adjacent to the site of extraction.
The aim of this study was to evaluate the autotransplantation of upper third molar for closing oaf. When oroantral communication is left open, epithelial tissue may develop in its track oroantral fistula. An oroantral communication oac is an open connection between the oral cavity and maxillary sinus. Oroantral communication closure using a pedicled buccal. Oroantral fistula oaf is an epithelialised oroantral communication oac. May 21, 2016 oroantral fistula oaf is a relatively uncommon complication of maxillary molar extraction. Introduction oac is a complication of surgery which result in a connection between oral cavity and maxillary sinus. Anteriorly based palatal flap for closure of large. Oroantral fistula oaf, also termed oroantral communication, is an abnormal condition in which there is a communicating tract between the. A late buccosinusal fistula in the 1516 tooth area. The creation of an oac is most commonly due to the extraction of a maxillary tooth closely related to the antral floor. Debride the socket and pack with gelfoam to help form a blood clot. A rotational flap of the buccal mucosa was then elevated with the bovieelectrocautery device. 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.
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