Management of Oroantral Fistulae and Communications: Our Recommendations for Routine Practice

Abstract

Oroantral communication (OAC) is one of the main complications of extracting antral or sinus teeth. OAC is a gap between the maxillary sinus and the oral cavity. When left untreated, it causes maxillary sinusitis and dramatically impairs the patient’s quality of life. Numerous surgical treatment techniques have been described, from mucosal techniques to using bone substitutes or very conservative alternative means. Many cases of recurrence after treatment have been reported, and the choice of the method adapted to the clinical situation remains challenging. Therefore, it is necessary to establish a correct diagnosis and choose the surgical technique best adapted to the case. This work is aimed at reviewing several techniques for the treatment of OAC and at describing our recommendations for use in daily practice for each of them through four clinical cases.

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications

“…Similar findings were found in a study of Mahamadou Konate et al, that sustain the fact that the buccal fat pad flap has promising results, but that it may present necrosis if used in a single layer. In our study all of the patients were treated with Bichat fat pad flap in a single layer, thus avoiding the reduction of the vestibule, without any signs of necrosis [ 9 ]. One article recommends using a double layer technique using septal cartilage for the bone defect and Bichat buccal fat pad with favourable results [ 16 ].…”

“…The disadvantages include a reduced vestibule and, in case of larger defects, wound dehiscence because of the affected blood supply in case of supplemental scoring. In addition, a constant traction is exercised on the flap during mastication and phonation, which may affect the healing process [ 9 ].…”

OROANTRAL FISTULA: An Overview

“…This technique is suitable for small children and defects of medium volume. 14 This technique consists of modifying the vestibular flap to avoid a decrease in the vestibular sulcus. After cutting the edge, two vertical incisions are made to provide the flap with dimensions suitable for the closure of antral communication.…”

“…Thus, a high success rate has been reported in the literature concerning this technique. 14 However, this flap technique also presents disadvantages, the risk of reduction in the depth of the buccal sulcus and postoperative pain and swelling. Loss of vestibular depth is a severe problem requiring additional vestibuloplasty in patients wearing removable dentures.…”

“…Haas et al recommend using bone grafts with monoblock's for OAC closure. 14 The disadvantages of this technique require a second surgical procedure for bone retrieval. This second procedure prolongs surgical time and improves patient morbidity, prolonged postoperative pain, and possible sensory impairment.…”