Tratamiento de comunicaciones bucosinusales y buconasales: Reporte de cinco casos de diferente etiología / Treatment of oroantral and oronasal communications: report of five cases with different etiology

Objetivo: Las comunicaciones bucosinusales y buco- nasales son condiciones patológicas que se caracterizan por la presencia de una solución de continuidad entre la cavidad bucal y el seno maxilar o la cavidad nasal respectivamente. Una vez que se ha instalado una comunicación es deseable ce- rrar este defecto, evitando así la infección del seno maxilar y posibles dificultades en la deglución, fonación y masticación. Se han propuesto diferentes tratamientos para su resolución, algunos no quirúrgicos y otros quirúrgicos. Los quirúrgicos pueden realizarse desplazando tejidos locales, regionales o injertando. El presente trabajo tiene como objetivo presentar situaciones clínicas de comunicaciones bucosinusales y buco- nasales con diferentes etiologías y sus distintos tratamientos según tamaño y ubicación del defecto. Casos clínicos: Se identificaron pacientes que asistie- ron al Servicio de Cirugía Maxilofacial del Hospital Piñero presentando cuatro comunicaciones bucosinusales agudas y crónicas y una comunicación buconasal crónica. Los casos analizados fueron tratados de manera quirúrgica utilizando di- versos colgajos según tamaño y ubicación del defecto (AU)

Aim: Oroantral and oronasal communications are patho- logical conditions characterized by the presence of a solu- tion of continuity between the oral cavity and the maxillary sinus or nasal cavity respectively. Once a communication has been installed, it is desirable to close this defect, thus avoid- ing infection of the maxillary sinus and possible difficulties in swallowing, phonation, and mastication. Different treatments have been proposed for its resolution, some non-surgical and others surgical. Surgical procedures can be performed by dis- placing local or regional tissue or by grafting. The aim of this case report is to present clinical situations of oral sinus and oral nasal communication with different etiologies and their different treatments according to the size and location of the defect. Clinical cases: A group of patients who attended the Maxillofacial Surgery Service of Piñero Hospital presenting four acute and chronic oral sinus and one oronasal communi- cations were identified. The analyzed cases were treated sur- gically using different flaps according to the size and location of the defect (AU)

The effectiveness of the two-layered closure of persistent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap.

Background: A prospective clinical study was conducted to assess the effectiveness of the two -layered closure of recurrent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap. Materials and methods: Twenty patients with persistent OAFs larger than 5 mm were treated with two layered closure using Buccal Fat Pad and Buccal Advancement Flap. They were followed clinically and radiographically for 5 years after surgery to monitor the durability and effectiveness of the two layered closure of the OAF. Result: The procedure was successful in all patients. The healing process was satisfactory,with no breakdown or liquefaction necrosis postoperatively. No complications were observed during the follow-up period. Conclusion: The results of this study support the view that the use of the double-layered closure using BFP with buccal advancement flap is a durable, convenient, and effective method for the treatment of a persistent large OAF.

Diagnóstico y tratamiento de la sinusitis maxilar odontogénica / Diagnosis and treatment of odontogenic maxillary sinusitis

RESUMEN Introducción: La patología sinusal inflamatoria e infecciosa puede comprometer la mucosa sinusal maxilar, etmoidal, esfenoidal o frontal, y su etiología es variada. Se ha observado que la patología odontológica es uno de los factores causales de la sinusitis maxilar, con una incidencia del 10% al 40% según diversas series de casos. El diagnóstico y tratamiento se debe realizar de manera interdisciplinaria entre las especialidades de otorrinolaringología y de cirugía maxilofacial. Se elaboró un documento descriptivo sobre la sinusitis odontogénica y orientador sobre su manejo, de acuerdo a una revisión de la literatura. Se realizaron búsquedas en las bases de datos PubMed, Lilacs y Google Académico, utilizando términos relevantes para la sinusitis odontogénica, con el fin de elaborar el documento. Se utilizaron 43 artículos, todos publicados desde el año 1986 hasta la fecha. Se concluye que la sinusitis odontogénica difiere tanto en la clínica como en la microbiología de otras enfermedades sinusales. El tratamiento se basa en el trabajo interdisciplinario e incluye cirugía endoscópica funcional, realizada por el otorrinolaringólogo, en conjunto con el tratamiento odontológico, siendo fundamental la buena comunicación entre ambos equipos.

ABSTRACT Introduction: Infectious and inflammatory sinus diseases have a varied etiology and can be associated to the maxillary, ethmoidal, sphenoidal and frontal sinuses. Dental pathology can be one of the etiological factors associated to maxillary sinus disease, with frequency rates of 10-40%. Diagnosis and treatment require interdisciplinary work, with participation of otorhinolaryngology and oral and maxillofacial surgery. The development of a descriptive document on odontogenic sinusitis and management guidelines according to literature review. Pubmed, Lilacs and Google Academic database were searched using terms relevant to odontogenic sinusitis, in order to prepare the document. 43 articles were used, all published from 1986 onwards. We conclude that odontogenic sinusitis differs clinically and microbiologically from other sinus pathologies. Treatment modalities are based upon interdisciplinary surgery, including functional endoscopic surgery done by otolaryngologists and dental treatment, being fundamental close communication between the two teams.

Utilização de corpo adiposo bucal em comunicação oroantral / Use of body adiposo body in oroantral communication

Introdução: A comunicação oroantral tem como principais causas etiológicas os processos patológicos, traumatismos e cirurgias, sendo comum sua ocorrência durante exodontias de elementos dentários superiores posteriores devido ao íntimo contato dos ápices radiculares com o assoalho do seio maxilar. Relato de caso: Paciente do sexo feminino, com 51 anos de idade, apresentando comunicação oroantral há 6 anos após exodontia do elemento dental 16. Realizado fechamento da comunicação oroantral sob anestesia local, com tracionamento e sutura da bola de Bichat sobre a falha óssea. Após um ano de proservação, observamos a ausência de comunicação bucosinusal bem como de sintomatologia, resultando no sucesso do tratamento. Considerações Finais: A utilização do retalho pediculado do corpo adiposo bucal é uma alternativa útil para o fechamento e tratamento de comunicações bucosinusais, sendo que o deslizamento da bola de Bichat é um método seguro para fechamento de tais comunicações e que esta é uma técnica de simples execução, com poucas complicações e limitações... (AU)

Introduction: The oroantral communication has as main etiological causes the pathological processes, traumatisms and surgeries. Its occurrence during the exodontia of posterior superior dental elements is due to the intimate contact of the root apices with the floor of the maxillary sinus. Case report: A 51-year-old female patient, presenting oroantral communication 6 years ago after the dental element 16 was extubated. The oroantral communication was closed under local anesthesia with Bichat's ball traction and suture on the bone defect. After 1 year of proservation, we observed the absence of oral communication, as well as symptomatology, resulting in the success of the treatment. Final considerations: It is concluded that the use of the pedicle flap of the buccal adipose body is a useful alternative for the closure and treatment of buco sinusal communications, and the sliding of the bichat ball is a safe method for closing such communications and that this is a technique of simple execution, with few complications and limitations... (AU)

Oroantral fistula after a zygomaticomaxillary complex fracture

Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a 2.0× 2.0 cm bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.

Cierre de comunicación oroantral mediante el uso de membrana de plasma: revisión de la literatura y reporte de un caso clínico / Closure of oroantral communication using a plasma membrane: review of the literature and report of a clinical case

Una comunicación oroantral es el espacio creado entre el seno maxilar y la cavidad oral, si ésta no es tratada a tiempo puede desencadenar una fístula e inclusive la presencia de sinusitis crónica. La comunicación oroantral es una de las complicaciones con mayor prevalencia que puede presentarse durante los procedimientos quirúrgicos cercanos a la zona donde se vea involucrado el seno maxilar. Con mayor incidencia encontramos los primeros molares, seguidos de los segundos molares y por último los terceros molares. El manejo convencional de una comunicación oroantral va desde su cierre espontáneo hasta el manejo quirúrgico; esto dependerá del tamaño de la lesión y el tiempo transcurrido de ésta. El caso clínico se trata de un paciente de 42 años de edad con antecedente de extracción del O.D. 16 por facultativo particular, desarrollando posteriormente un cuadro de sinusitis, por lo que acude al Servicio de Urgencias del Hospital Regional 1o de Octubre, I.S.S.S.T.E. en la CDMX, siendo valorado por nuestro servicio, donde se observa una comunicación franca entre la cavidad bucal y el seno maxilar, realizándose cierre de la misma con una membrana de plasma rico en factores de crecimiento plaquetario (AU)

Oroantral communication is the space created between the maxillary sinus and the oral cavity, if the communication is not treated on time, it would progress to oroantral fi stula or chronic sinus disease. An oroantral communication is the most common complication during surgical procedures closer to the maxillary sinus. With greater incidence we found sites of upper fi rst molar, followed by the second molar and fi nally third molars. The conventional handling of an oroantral communication goes between spontaneously closure or surgical closure management, it will depend in the size of the lesion and the time elapsed. The present article shows a clinical case, is a male patient of 42 years old with a previous extraction of tooth 16, by a private doctor, later developing a picture of sinusitis. Then he goes to the emergency department of the Hospital 1o of October, ISSSTE in the CDMX, being evaluated by our service, where there is a frank communication between the oral cavity and the maxillary sinus, closing it with a plasma membrane rich in growth factors (AU)

Desplazamiento por iatrogenia de tercer molar a seno maxilar: reporte de caso clínico / Third molar iatrogenic displacement to maxillary sinus: report of a clinical case

La relación de los dientes posteriores superiores respecto al seno maxilar tiene connotaciones clínicas importantes, uno de los principales riesgos es el desgarro o perforación de la membrana sinusal (Schneider) y la proyección del diente involucrado, en procedimientos de extracción dental y extracción quirúrgica de raíces. El rescate de un tercer molar superior dentro del seno maxilar requiere tener un área o acceso sufi ciente, que permita visualizarlo y removerlo con facilidad, para tal fi n la técnica quirúrgica de ventana lateral Caldwell-Luc suele ser la de primera elección. El presente artículo muestra un caso clínico de desplazamiento al seno maxilar por iatrogenia durante el intento de extracción de un tercer molar, y su resolución quirúrgica (AU)

The relationship of the maxillary posterior teeth to the maxillary sinuses has important clinical connotations. One of the main risks is the rupture or perforation of the sinus membrane (Schneider) and the projection of the tooth involved in the dental extraction and procedures of surgical extraction of the roots. Rescue of a third upper molar within the maxillary sinus requires a suffi cient access area, which allows visualization and extraction with ease, for this the surgical technique of the side window Caldwell-Luc is usually the fi rst choice. The present article shows a clinical case of displacement to the maxillary sinus by iatrogeny during the extraction of a third molar, and its surgical resolution (AU)

Repair of an oroantral communication by a human amniotic membrane: a novel technique

The amniotic membrane is the innermost layer of fetal membrane and is attached to the chorion in the placenta. This membrane has been used for nearly a century in varied fields such as ophthalmology, reconstructive surgery, and burn treatment. In this case report, we used a human amniotic membrane to repair an iatrogenic oroantral communication that occurred during the extraction of the patient's right upper second molar. A splint was given after the perforation was covered with human amniotic membrane and healing was clinically evaluated at various intervals. The outcome of the study revealed that the human amniotic membrane was an efficient graft material for repairing the defect caused by an iatrogenic oroantral communication following tooth extraction.

Colgajos locales y pediculados en el manejo de las comunicaciones y fístulas oroantrales / Local and pediculated flaps in the management of oroantral communications and fistulas / Retalhos locais e pediculados no tratamento das comunicações e fistulas oroantrais

El manejo convencional de las comunicaciones oroantrales ha sido a través de técnicas quirúrgicas locales que a través del tiempo aun siguen vigentes para el manejo primario de dicha complicación. La mejoría del conocimiento de la anatomía detallada de la región maxilofacial ha introducido nuevas técnicas con el objetivo de mejorar e incluso tener nuevos alcances con respecto al manejo de las comunicación y fistula oro antrales que con las técnicas clásicas no se lograban. Esta revisión de tema muestra cada una de las opciones disponibles para el manejo de las comunicaciones y fistulas oro antrales con sus indicaciones, técnica quirúrgica y complicaciones...

The conventional management of oroantral communications has been performed through local surgical techniques which over time are still in vigor for the primary management of that complication. The improvement in the understanding of the maxillofacial region detailed anatomy has leaded to the introduction of new techniques with the aim of improving and even obtaining new achievements regarding the management of oroantral communication and fistulas which were not accomplished with the classical techniques. This subject review shows each one of the available options for the management of oroantral communications and fistulas with their indications, surgical techniques and complications...

O tratamento convencional das comunicações oro-antrais tem sido através de técnicas cirúrgicas locais que através do tempo ainda continuam vigentes para o tratamento primário dessa complicação. A melhoria do conhecimento da anatomia detalhada da região maxilo facial introduziu novas técnicas com o objetivo de melhorar e inclusive ter novos alcances com respeito ao tratamento das comunicações e fistula oro-antrais que com as técnicas clássicas não era possível. Esta revisão de tema mostra cada uma das opções disponíveis para o tratamento das comunicações e fistulas oro-antrais com suas indicações, técnicas cirúrgicas e complicações...

Cierre de fístula oroantral con injerto óseo y con rotación y avance de colgajo palatino / Surgical repair oroantral fistula with a rotation and advancement palatal flap and autologous bone graft

La fístula oroantral se presenta entre otras causas como resultado de la extracción de un molar en relación al maxilar Como consecuencia el paciente presenta episodios de sinusitis de evolución tórpida y refractaria a tratamiento médico, siendo la reparación quirúrgica su mejor solución, existiendo distintas técnicas. El objetivo de este caso es mostrar la experiencia de un paciente operado mediante la utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se trata de una mujer de 32 años que dos semanas después de extracción de molar superior izquierdo presenta reiterados episodios de sinusitis unilateral izquierda. Al examen físico y estudio con tomografía computarizada se diagnostica sinusitis maxilar izquierda, secundaria a fístula oroantral por extracción de pieza dentaria del maxilar. Se realiza reparación quirúrgica con utilización de un colgajo de rotación y avance palatino e injerto de hueso autólogo. Se realizó seguimiento por 6 meses con resultados óptimos, sin complicaciones ni recidivas. Las fístulas oroantrales son un problema que tiene múltiples opciones de tratamiento quirúrgico. La utilización de injertos óseos autólogos y la utilización de un colgajo de rotación y avance palatino, pretende ser una buena opción quirúrgica, permitiendo un cierre definitivo del defecto.

Oroantral fistula occurs between other causes as a result of the extraction of a molar in relation to the maxillary bone. As a result the patient experiences episodes of sinusitis refractory to medical treatment. Surgical repair remains the best solution, there are different techniques. The aim is to show our experience of one case operated using a rotation and advancement palatal flap and autologous bone graft. The clinical case is a 32 year old woman that two weeks after removal of upper left molar suffers repeated episodes of unilateral sinusitis. Physical examination and computed tomography shown left maxillary chronic sinusitis secondary to an oroantral fistula, due to tooth extraction from maxillary bone. Surgical repair is performed using a rotation and advancement palatal flap and autologous bone graft. Six months following there was no complication neither recurrent sinusitis, with optimal results. Oroantral fistula is a problem that has multiple options for surgery. The use of autologous bone graft and rotation and advancement palatal flap intended to be a good surgical option, allowing closure of the defect.

Clinical Evaluation of the effectiveness of pedicled buccal fat pad grafts in closure of oroantral communications

The author evaluated the effectiveness of pedicled buccal fat pad grafts for closure of oroantral communications. Nine patients with chronic oroantral communications and one patient with an oronasal communication were treated with pedicled buccal fat grafts. They were treated successfully in all cases, and there were no postoperative complications (i. e. shallow buccal vestibule), and minimal patient discomforts. It was concluded that this was a easy and time fast method for closure of oral defects and had wide application and high successful rate