Decision-making in closure of oroantral communication and fistula

Abstract

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. 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. There are different ways to perform the surgical closure of the OAC. The decision-making in closure of oroantral communication and fistula is influenced by many factors. Consequently, it requires a combination of knowledge, experience, and information gathering. Previous narrative research has focused on assessments and comparisons of various surgical techniques for the closure of OAC/OAF. Thus, the decision-making process has not yet been described comprehensively. The present study aims to illustrate all the factors that have to be considered in the management of OACs and OAFs that determine optimal treatment.

Collagen Strip Technique: A Novel Approach for Ridge Preservation and Concomitant Oroantral Communication Management After Implant Explantation

“…Root apex approximation or projection in the maxillary sinus is a major risk factor for OAC occurrence 1 . Other OAC etiologies include trauma, infection, pathology and implant complications 2 …”

“…The currently available allogeneic, xenogeneic and alloplastic materials can successfully replace autogenous grafts in OAC management 7–9 . When selecting an appropriate approach for OAC management, several factors should be considered: OAC dimensions, presence of infection or foreign body and future reconstruction plan 2 …”

Tratamento de fístula bucosinusal após exodontia com corpo adiposo da bochecha e retalho vestibular em paciente diabético: relato de caso

“…A comunicação bucosinusal pode ser confirmada com a manobra de Valsalva, que consiste na pressão positiva de ar gerada pelo paciente contra as narinas fechadas, havendo o escape de ar pela fístula muitas vezes gerando um ruído sibilante 4 . Radiograficamente, onde o exame complementar ideal é a tomografia computadorizada, a comunicação bucosinusal caracterização pela descontinuidade do assoalho do seio maxilar, podendo haver o espessamento da mucosa do seio em casos crônicos bem como sinusopatias 1 .…”

“…O processo de epitelização é evidenciado na cavidade oral no sétimo dia pósoperatório e é completa na 3ª ou 4ª semana por um processo de metaplasia 16 . Estudos mostram altas taxas de sucesso desta técnica, bem como sua variação com a associação a outras camadas durante o fechamento como o retalho vestibular 3,4,7,8,16 . Diante do exposto, o objetivo deste relato de caso é apresentar o fechamento de uma fístula bucosinusal através do retalho pediculado do corpo adiposo bucal abordando diagnóstico e técnica cirúrgica.…”

A combined staged novel approach for reconstruction of persisting Oro-antral fistulae defects utilizing tripled layer closure and open sinus lifting

“…(1) The epithelial tract represents a pathologic pathway from the oral cavity to the antrum, through which bacterial invasion and consequent sinusitis occur which in turn complicates the healing of the violated membrane, surgical removal of the epithelial tract always considered the standard setup after confirmation of irradiation of the persisting infection. (2) Although most of the Oro-antral fistulae are usually treated with high success rates with local flaps such as buccal or palatal advancement flaps, the persistent chronic fistula as well as those with failed previous surgical closure; with subsequent morbidity and deficient vascular state are difficult to manage and usually requires more advanced surgical maneuvers. (3,4) Several surgical modalities have been postulated for closure of chronic fistulas; counting transposition of local soft tissue flaps, utilizing autogenous bones, xenografts and various alloplastic and synthetic materials, aiming to improve the vascular state of the compromised bed, to obliterate the dead space and to support the transpositioned soft tissue flaps looking forward to secure intimate soft tissue closure intending to provide long term sealing of the maxillary sinus.…”