Transmaxillary anchored silicon embedded gauze plug in the post‐operative treatment of a large oromaxillary fistula caused by a supernumerary cheek tooth

Abstract

Summary A 9‐year‐old Hungarian sport horse gelding was presented to the clinic in poor condition displaying malodorous bilateral purulent nasal discharge. Oral examination revealed the presence of supernumerary 111 and 211. Bilateral diastema formation between the third maxillary molars and the supernumerary teeth with deep periodontal pockets and massive food impactions were diagnosed endoscopically. Radiography revealed inhomogenous sinus opacities in the left and right paranasal sinuses. Following bilateral oral extractions of the supernumerary cheek teeth and third maxillary molars, bilateral oromaxillary fistula formations were diagnosed (about 17 mm diameter on the right side). Bilateral frontal and right‐sided maxillary trephinations and resection of the right bulla of the maxillary septum were performed. Massive food impactions of the left and right paranasal sinuses were removed under endoscopic control. Repeated trans‐endoscopic sinus lavage was performed post‐operatively. After 2.5 months, the large right‐sided oromaxillary communication was temporarily closed with a transmaxillary anchored, gauze‐cored silicon plug on an outpatient basis. Follow‐up examination after 187 days revealed complete closure of the oromaxillary fistula and absence of sinusitis. In a 1.5‐year follow‐up control, no pathological conditions were found.

Orosinuidal and oronasal fistulas: The search for an adequate treatment

“…The technique described by Hevesi et al . () to obturate the fistula with a gauze‐cored silicone plug fulfils the criteria above and was successful in this case. However, the authors reported that in the beginning, the silicone plug was inserted too deeply into the fistula, which impeded the healing process.…”

“…In the case described by Hevesi et al . (), the alveolar healing led to the closure of the smaller fistula in the left arcade (211/s211). Granulation in the alveolus 111/s111 decreased the diameter of the fistula but did not close it.…”

“…Similar to the described case by Hevesi et al . (), the related sinus compartments are often filled with inspissated pus and food material. As a consequence of the chronic infection, leucopenia and weight loss can be observed frequently in cases with a long medical history.…”

“…Similar to the case described by Hevesi et al . (), bone flaps can become necrotic because of the likely bacterial contamination and the reduced blood perfusion. The bone of the 39‐mm frontal bone trephination is therefore removed and bone necrosis is not an issue; skin closure usually leads to good cosmetic results, especially if the periosteum and skin layers are sutured in separate layers.…”

“…As described in the Case Report by Hevesi et al (2019), routine therapy in these cases consists of alveolar flushing and debridement to remove necrotic tissue and food material after extracting the supernumerary and, if indicated, the adjacent tooth (Quinn et al 2005). Debridement should not be too aggressive to prevent unnecessary enlargement of the presented defect.…”