Surgical options in oroantral fistula treatment article pdf available in the open dentistry journal 61. Oroantral fistula definition of oroantral fistula by. Various surgical options pulkit khandelwal 1, neha hajira 2 abstract 2ur dqwudofrppxqlfdwlrqdqg. 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. There was no discharge from the fistula or any signs of acute infection. 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. It is the purpose, therefore, of this paper to outline those modern measures which have proved most successful in the treatment of this condition. The fundamentals of treatment of acute oroantral fistulas include 1 adequate antimicrobial therapy, preferably penicillin. Material and methods in the past four years i have treated 41 patients with oroantral fistulas. 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. The term oroantral fistula is similar to but not synonymous with the term oroantral communication oac. Oroantral communication is a pathological communication between the oral and antral cavities.
Oroantral communication followed by oroantral fistula oaf is a rare surgical complication in oral and maxillofacial surgery. Pdf surgical options in oroantral fistula treatment. Openings smaller than 2 mm may heal spontaneously, whereas larger openings require surgical treatment. The treatment of oroantral communications should be performed immediately when the opening is created or later in cases of failure of primary closure schow9. 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. May 21, 2016 oroantral fistula oaf is a relatively uncommon complication of maxillary molar extraction. Infection, cysts or other pathology will weakens the bone around the roots of teeth may make an opening more likely to occur. 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. A preliminary study of monocortical bone grafts for oroantral fistula closure. While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla. An oroantral communication oac is an open con nection between the oral.
Unilateral odontogenic sinus infection is treated and cured by drainage and removal of the odontogenic cause. Surgical options in oroantral fistula treatment ncbi. 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. Herein, we present a case of oroantral communication that was to be treated with clinical examination, tomography, and prototyping. Oral fistula oaf is a pathological communication between the oral cavity and maxillary sinus which has its origin either from. Samir gendy consultant ent surgeon, emersons green nhs treatment centre, uk. B circular incision around the fistula and mucosa displacement on the fistulous path. This retrospective single center study includes all patients with. This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons. Primary closure of a sinus perforation primary closure of a sinus perforation is indicated for large. Oroantral fistula oaf is an abnormal condition that manifests a pathological communication between the maxillary sinus and the oral cavity.
Management of oroantral fistula linkedin slideshare. The treatment need an approach that presents the capacity to promote closure of the communication or fistula, leading to the recovery of health. Treatment of oroantral fistula with autologous bone graft and. Treatment of oroantral fistula jama otolaryngologyhead.
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. The management of bisphosphonate related necrosis of the jaw has become clinical routine. Development of an oroantral fistula following sinus elevation surgery. Oroantral communication oac acts as a pathological pathway for bacteria and can cause infection of the antrum, which further. Clinical figure 1 and radiographic investigation figure 2 revealed oroantral communication in the vestibular ridge.
Treatment of chronic oroantral fistula with plateletrich fibrin clot and collagen membrane. The oroantral fistula oaf develops if the oac remains open and becomes epithelialized. Closure of oroantral fistula by using buccal fat pad or buccal advancement flap. Chlorhexidine gel was regularly applied to the fitting surface of the splint and the oroantral communication.
There is a necessity for improvement in the manner in which these lesions are managed. Oroantral fistula an overview sciencedirect topics. Oroantral fistula is a communication between maxillary sinus and oral cavity, dental diseases has been reported recently in 30% of maxillary sinusitis cases, the. Oroantral fistula oaf is an epithelialised oroantral communication oac. Pdf closure of oroantral fistula by using buccal fat pad or.
When oroantral communication is left open, epithelial tissue may develop namely oroantral fistula. Note the opacification of the maxillary sinus, indicating chronic infection. Treatment of oroantral communication using the lateral. Four month a go a sinus lift was performed and an oroantral communication and fistula was created. A coronal ct scan of the sinuses, showed a defect in the floor of the left maxillary antrum, corresponding to the oroantral fistula. 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. Closure of oroantral communication using buccal advancement. Treatment of oroantral fistula with autologous bone graft and application of nonresorbable. An oroantral perforation is an unnatural communication between the oral cavity and maxillary sinus. Case of oroantral communication closure using a pedicled buccal fat pad graft. Decisionmaking in closure of oroantral communication and. Oroantral communication closure using a pedicled buccal fat.
Oroantral communication is the consequence of a loss of continuity between the maxillary sinus and the oral cavity. 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. In 4050 % of maxillary necrosis the maxillary sinus is involved, leading to maxillary sinusitis and oroantral communications. 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. Surgical options in oroantral fistula treatment europe pmc. C absorbable 40 catgut suture on the right maxillary sinus mucosa. The oac is often confused with the oroantral fistula oaf which is defined as a persistent epithelialized open communication.
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. 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. The primary purpose is to close the communication and prevent sinusitis. Often neither the patient nor the dentist will be aware of the hole. Nonsurgical management of an oroantral fistula in a. It is the purpose, therefore, of this paper to outline those modern. Unusual etiology and diagnosis of oroantral communication due. An oroantral fistula refers to an epithelialized pathological unnatural communication between the oral cavity and the maxillary sinus. The closure of an oroantral communication of any origin, can be achieved by different techniques. Acute oroantral fistula extraction of one of the upper molar teeth is the usual cause of acute oroantral fistulas. Clinical decisionmaking determines the optimal strategy in a particular clinical situation.
Oaf closures can be achieved using different flaps which show both advantages and limitations. Modern management of oroantral fistula jama otolaryngology. No treatment required as it will usually naturally heal. 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. An oroantral fistula will not heal spontaneously and must be surgically repaired. 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. 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.
May 25, 2015 four month a go a sinus lift was performed and an oroantral communication and fistula was created. Review open access surgical options in oroantral fistula management. 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. Decisionmaking in closure of oroantral communication and fistula. The oroantral fistula oaf is a pathological communication between the oral cavity and the maxillary sinus. The case was send it to us in order to repair and to build a. Oro antral fistula it is an abnormal epithelized communication between maxillary sinus and oral cavity through perforation in the sinus wall 3. 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. Popularized treatments of the oroantral communication. 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. Treatment modalities to repair the oroantral fistula include local or free soft tissue flaps, with or without autogenous grafts or alloplastic implants. Pdf communication between the maxillary sinus and oral cavity is a common complication in oral surgery. Alternative method to treat oroantral communication and fistula with. Pdf management 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. Treatment of oroantral fistula with autologous bone graft and application of a nonreabsorbable membrane. 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. Small openings are very common and will usually heal by themselves with no treatment. An oroantral fistula is an epithelialized, pathological, unnatural communication between these two cavities. Of these 12 had socalled acute fistulas and 29 had chronic fistulas. Treatment of oroantral fistula a study mucoperiosteal flap is created and suture over the defect. Various surgical methods and approaches have been described in the literature for the treatment of oroantral fistulas and each of them has its specific. Oaf mostly results from insufficient knowledge and preparation before dental. Saleh bakry assistant professor of oral and maxillofacial surgery 2. Treatment of chronic oroantral fistula with plateletrich.
Treatment of oroantral fistula with autologous bone graft. Oroantral fistulae may develop postoperatively, especially if the patient has a history of past sinus pathology or infection. 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. Many chronic oroantral fistulas treated in the past could have been prevented had certain steps been taken immediately after their occurrence. Oac refers to an abnormal connection between the oral cavity and antrum or maxillary sinus. Oroantral, fistula, flaps, grafts, maxillary sinus, complication management, oral surgery, decision, oroantral communication. A late buccosinusal fistula in the 1516 tooth area. 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.
Small oroantral fistulae treatment with systemic antibiotic drugs and daily rinses with chlorhexidine. The operated case had no complications and the oroantral communication was cured. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. 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. Comparative study, authorahmad al nashar and hasan m. Management of oroantral communication using buccal advanced flap. Oroantral fistula article about oroantral fistula by the. Upon clinical examination, an approximately 10mm fistula was observed connecting the oral cavity to the maxillary sinus.
They are therefore first seen by the dentist, although the rhinologist may be consulted to help care. Adele scattarella, andrea ballini, felice roberto grassi, andrea carbonara, francesco ciccolella, angela dituri, gianna maria nardi, stefania cantore, francesco pettini. Treatment plan has been explained to the patient, and preoperative medications were advised. The diagnosis was established using the nose blowing test and probing introduction of a silver probe into the antrum through the fistula. The case was send it to us in order to repair and to build a new condition for the implant placement. The oroantral fistula has its origin either from iatrogenic complications or from dental infections, trauma, radiation therapy, or osteomyelitis. Oroantral fistula oaf is a relatively uncommon complication of maxillary molar extraction. Oroantral fistula oaf is an epithelialized communication between the oral cavity and the maxillary sinus.
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