Surgical options in oroantral fistula management: a narrative review

Abstract

An oroantral fistula (OAF) is a pathological abnormal communication between the oral cavity and the maxillary sinus which may arise as a result of failure of primary healing of an OAF, dental infections, osteomyelitis, radiation therapy, trauma, or iatrogenic complications. With the presence of a fistula, the maxillary sinus is permanently open. Microbial flora passes from the oral cavity into the maxillary sinus, and the inflammation of the sinus occurs with all potential consequences. In literature, various techniques have been proposed for closure of OAFs. Due to the heterogeneity of the data and techniques found, we opted for a narrative review to highlight the variety of techniques discussed in the literature. Techniques of particular interest include the bone sandwich with resorbable guided tissue regeneration (GTR) membrane and platelet-rich fibrin (PRF) used alone as both a clot and a membrane. The great advantage of these techniques is that no donor site surgery is necessary, making the outcome valuable in terms of time savings, cost and, more importantly, less discomfort to the patient. Additionally, both bony and soft tissue closure is performed for OAF, in contrast to flaps, which are typically used for procedures in the sinus area. The reconstructed bony tissue regenerated from these techniques will also be appropriate for endosseous dental implantation.

Fechamento cirúrgico de comunicação buco-sinusal com uso de L-PRF: um relato de caso

“…Apesar das inúmeras técnicas descritas para o manejo de comunicações buco-sinusais, o fechamento absoluto a longo prazo é uma tarefa desafiadora, sendo determinante a análise dos fatores locais e sistêmicos que estão associados com a taxa de sucesso do procedimento (Parvini et al 2018). Atualmente, não existe evidência científica quanto à abordagem mais apropriada para estes casos (Gheisari et al 2019;Li et al 2019).…”

“…A comunicação patológica entre a cavidade bucal e o seio maxilar é uma sequela frequente de eventos traumáticos na região posterior da maxila. Suas principais causas incluem a ressecção de tumores e cistos maxilares, ferimentos por projétil de arma de fogo, Research, Society and Development, v. 9, n. 10, e2359108502, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i10.8502 lesões penetrantes no palato e exodontia de molares e pré-molares superiores com raízes longas (Dym H, Wolf JC 2012, Parvini et al 2018.…”

“…O objetivo do tratamento da comunicação buco-sinusal é o fechamento do defeito existente, promovendo o isolamento do seio maxilar da cavidade bucal, o que possibilita o reparo adequado e o restabelecimento funcional dos tecidos adjacentes(Gheisari et al 2019).Existem várias técnicas preconizadas com indicações e taxas de sucesso variáveis, influenciadas por fatores como as dimensões do defeito ósseo, o estado de saúde do paciente, tabagismo, nível de higiene bucal e hábitos parafuncionais associados.Defeitos com diâmetro inferior a 5 mm respondem bem a técnicas de retalhos locais, entretanto defeitos extensos necessitam de abordagens mais complexas como retalhos pediculados com o corpo adiposo da bochecha, obliteração com biomateriais e enxertos ósseos(Parvini et al 2018). O uso de fatores bioativos, como os concentrados plaquetários, tem ganhado força na reconstrução do tecido ósseo e cicatrização de feridas.…”

Multiple myeloma and pulmonary aspergillosis: dental treatment prior to chemotherapy and management of post extraction complications

“…The most likely cause is the failed primary closure of an oroantral communication secondary to a dental extraction, however could also be related to dental infection, trauma, osteomyelitis, cysts or tumour-like growths, or radiation therapy and can be more susceptible in myelosuppressed individuals. 11 The communication allows bacteria from within the oral and the maxillary sinus to pass between each other, resulting in chronic infection and inflammation of the sinus lining.…”

A Sino-orbitocutaneous Fistula from Local (Native) Tonsillectomy: A Case Report

“…It could also be a challenging complication of midface and orbital resection and reconstruction. [1] They could lead to functional and cosmetic problems such as malodorous discharge, pain, crusting, further wound breakdown, difficulty with noseblowing, hypernasal speech, or inability to wear an orbital prosthesis [3,2,4].…”