Management of oroantral communication using buccal advanced flap.

Oroantral communication (OAC) or fistula (OAF) is an open pathological communication between the oral cavity and maxillary sinus which mostly occurs as a result of extraction of upper molars and premolars, iatrogenic complications or from dental infections, osteomyelitis, radiation therapy or trauma. Several alternative techniques modalities have been described throughout the years for the management of OAC and OAF which show both advantages and limitations. The most employed surgical flaps are of three types: advanced buccal flap, palatal flap and buccal fat pad flap. The authors present two clinical cases: oroantral communication and oroantral fistula, both were treated by using buccal advancement flap.

Computed tomographic description of the highly variable imaging features of equine oromaxillary sinus and oronasal fistulae.

Oronasal and oromaxillary sinus fistulae are well-documented complications following removal or loss of a maxillary cheek tooth. Diagnosis is currently based on a combination of oral examination, videoendoscopy, radiography, and computed tomography (CT). The objective of this retrospective, case series study was to describe the CT characteristics of confirmed oronasal and oromaxillary sinus fistulae in a group of horses. Inclusion criteria were a head CT acquired at the authors' hospital during the period of 2012-2017, a CT diagnosis of oronasal or oromaxillary sinus fistulae, and a confirmed diagnosis based on a method other than CT. Signalment, clinical findings, oral examination findings, presence of a confirmed fistula, and method for confirmation of the diagnosis were recorded. A veterinary radiologist reviewed CT studies for all included horses and recorded characteristics of the fistulae. Seventeen horses were sampled. Fourteen oromaxillary sinus fistulae and three oronasal fistulae were identified. All fistulae appeared as variably sized focal defects in the alveolar bone. Defects frequently contained a linear tract of heterogeneous material interspersed with gas bubbles, considered consistent with food. Computed tomographic attenuation of the material (Hounsfield units, HU) varied widely within and between cases. In 16 of 17 cases, there was evidence of concurrent dental disease in addition to the fistulae. Although the gold standard diagnostic test remains identification of feed material within the sinus or nasal passages, findings from the current study support the use of CT as an adjunctive diagnostic test for assessing the extent of involvement and presurgical planning.

Tratamento de fístula bucossinusal com o uso de retalho do corpo adiposo de Bichat û relato de caso / Treatment of oroantral communications using pedicled buccal fat pad graft û case report

Fístulas bucossinusais são comunicações epitelizadas entre o meio oral e o seio maxilar. Ocorrem principalmente como complicação de intervenções cirúrgicas orais e maxilofaciais. Pequenas comunicações geralmente são autorresolutivas, porém nas comunicações maiores, um tecido epitelial pode desenvolver-se em torno do seu trajeto, configurando, assim, uma fístula bucossinusal. Vários métodos de tratamento para fístula bucossinusal têm sido descritos na literatura. Devido à facilidade de acesso e rico suprimento sanguíneo, o corpo adiposo bucal é adequado para obliteração de defeitos posteriores da maxila, tanto na região de palato duro e mole, como na região alveolar e retromolar. Este trabalho objetiva relatar o caso clínico de uma fístula bucossinusal na região de rebordo alveolar maxilar esquerdo proveniente de um procedimento cirúrgico para levantamento de seio maxilar realizado há dois meses. Foi realizada antibioticoterapia para controle da infecção sinusal e tratamento cirúrgico da fístula pela técnica de retalho pediculado do corpo adiposo de Bichat, onde o mesmo foi dissecado, fracionado para a área comprometida e estabilizado à mucosa adjacente. A paciente encontra-se em acompanhamento há um ano sem queixas e/ou sinais de recidiva...

Oroantral fistula are epithelized communications between the oral environment and the maxillary sinus. They occur mainly as a complication of oral and maxillofacial surgery. Small communications are usually self resolving, but in major communications, an epithelial tissue can develop around your path, so setting a oroantral fistula. Various methods of treatment for buccal sinus fistula have been described in literature. Due to the ease of access and rich blood supply, the buccal fat pad is suitable for obliteration of later defects of the jaw, both in the area of hard and soft palate, as in alveolar and retromolar region. This is a case report of a oroantral fistula on the left maxillary alveolar region from a surgical procedure to maxillary sinus survey conducted two months ago. Antibiotic therapy was performed to control sinus infection and surgical treatment of fistula by pedicle flap technique of the fat pad of Bichat, where it was dissected, split to the affected area, and stabilized to the adjacent mucosa. The patient has been followed for a year without complaints and/or signs of recurrence...

Oronasal fistula repair using auricular cartilage.

Seven oronasal fistula lesions secondary to extraction of maxillary canine teeth were treated in 5 dogs using a cartilage graft harvested from the ipsilateral auricular pinna. All dogs had undergone previous, unsuccessful surgeries in attempt to repair the defects. The technique is described in a step-by-step fashion for easy reproduction. The authors found the technique to be straightforward, relatively quick, and successful in all 7 lesions.

The buccal fat pad flap: an option to prevent and treat complications regarding complex zygomatic implant surgery. Preliminary report.

PURPOSE: To evaluate the use of the buccal fat pad flap (BFPF) technique as an option to prevent complications in the treatment of patients with atrophic maxillae rehabilitated after complex zygomatic implant surgery. MATERIALS AND METHODS: A retrospective study was made of completely edentulous patients submitted to zygomatic implant surgery between May 2005 and November 2007. Patients with severely atrophic maxillae received conventional and zygomatic implants and were followed after the implants were loaded. Preoperative evaluation included panoramic radiography and computed tomographic scans of the maxilla to identify the anatomic conditions and presence of pathology. RESULTS: Eight male patients with a mean age of 57 years and atrophic maxillae were rehabilitated with zygomatic implants placed using the BFPF technique. The BFPF technique was used in complex situations, including oroantral communication-associated sites, areas that had lost the sinus wall, and extrasinus implant placement. A total of 16 conventional implants, 4 long (21-mm) tilted implants, and 22 zygomatic implants was placed. The patients were rehabilitated with fixed prostheses and were followed for a minimum of 15 months. None of the conventional implants failed and none of the zygomatic implants failed or presented with soft tissue complications. CONCLUSION: The BFPF presented a high success rate, demonstrating that it is a viable and predictable treatment option to prevent and treat soft tissue complications in complex zygomatic implant surgery.

Cierre de una fístula oroantral usando cemento óseo y un colgajo de mucosa yugal / Closure of an oroantral fistula using bone cement and a jugal mucosa flap

Una fístula oroantral es una solución de continuidad patológica entre el seno maxilar y la cavidad oral, producida frecuentemente tras una extracción dentaria, en la mayoría de los casos, del primer o segundo molar. El síntoma más común que provoca es una sinusitis aguda, que evolucionará a la cronicidad si la fístula permanece. El diagnóstico se realiza mediante endoscopia transalveolar, ortopantografía o tomografía computarizada dental. Su cierre quirúrgico es necesario cuando la fístula tiene más de 3 mm, o no sella por sí misma en 3 semanas. Existen, para ello, varias técnicas, usando distintos materiales y colgajos, cuyo fin es ocluir, tanto el defecto óseo, como el mucoso, para solucionar así a la vez la fístula y el problema sinusal(AU)

The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. The diagnosis is made by transalveolar, orthopantography or dental computerized tomography. Its surgical closure is necessary when the fistula has more than 3 mm or not seal by itself in three weeks. For it, there are some techniques using different materials and flaps where its objective is to occlude the bone defect as well as the mucous one thus solving the fistula and the sinus problem(AU)

Closure of palatal fistula with buccal fat pad flap.

Palatal fistula as a complication of palatal surgery is difficult to manage due to the presence of fibrotic and scarred tissue and the absence of local virgin tissue. Recurrence rates are high. To investigate the efficacy of repairing small and medium sized palatal fistulas using the buccal fat pad (BFP), 20 patients (aged 2.5-19 years) with palatal fistula (10-20mm) underwent closure surgery using a pedicled BFP flap. The nasal layer was closed by a local mucosal flap (turn down flap) and the pedicled BFP flap was used for oral lining. Full epithelialization of the BFP layer was observed within 4 weeks in all patients. A 2mm defect in the anterior part of the previous fistula location remained in one case, which spontaneously healed after 2 months; all others closed successfully. Mild pain and cheek swelling occurred in 10 patients, which disappeared within 5 days with no surgical intervention. This study suggests the pedicled BFP flap is a simple and relatively secure method for palatal fistula management. It is recommended for fistulas less than 20mm in length located in the posterior two-thirds of the palate.

[Stimulation of mucoperiostal slice epithelization by small power laser after the primary plastic of oroantral communication].

INTRODUCTION: The oroantral communication is a pathologic communication between the oral cavity and maxillary sinus. It originates with extraction of the upper lateral teeth. Primary plastics communication, which is more extensive than 5 mm has been unsuccessful in 16%. Small power lasers have positive reaction on wounds healing. The aim of this work was to determine the lasers effects on slice epithelization after the plastics more extensive than 5 mm. MATERIAL AND METHODS: The experimental research was done on dogs with extraction of the upper second premolars on both sides, and formed oroantral communication having diameter of 10 mm. After the plastics of sinus, the left side slices were exposed to radiation for 7 days, and the opposite slices healed spontaneously. Eight points (8x1J) were treated for 100s by GaAlAs laser, power 10 mW and wavelength 670 nm. Biopses of the slices connections were taken on the 14th day to be laboratory treated and examined microscopially. The study included 36 examinees with communication diameter of 10 mm and performed plastics of sinuses. In half of the examinees wounds were exposed to radiation for 7 days, and in other examinees they healed spontaneously. The results were analyzed on the fourteenth day according to the scale: (1) complete healing, without dehiscention; (2) incomplete healing, with minimal dehiscention; (3) communication did not heal, with partial dehiscention; (4) open communication, with significant dehiscention. RESULTS AND DISCUSSION: The microscopic analysis shows that no wounds exposed to radiation were overcast with mucous membrane which had smooth sub epithelia chronic inflammation and inflammable infiltrate, and strong fibroplasias and granulations. Wounds exposed to radiation had mucous membrane without any signals of inflammation. Laser radiation causes anti-inflammatory reaction, i.e., it provokes reduction of exudation, alteration and proliferation, it blocks cyclo- and lipo-oxygenation by delaying the synthesis of prostaglandin, stimulates neutrophyll, macrophage and lissome activity and it activates the function of immune complex T and B lymphocytes, so this difference could be primary referred to the action of laser. Our clinical study shows that complete healing of oroantral communication was recorded in 88.8% of the examinees who were exposed to radiation in relation to 50%, of those who did not receive radiation therapy which is statistically much higher percentage (chi2 test < 0.05). The surgery was repeated in 5.6% of those who had received radiation therapy and in 16.7% of those who had not been exposed to radiation. Laser radiation stimulates changing of ADP in ATP and it accelerates cells metabolism, it increases microcirculation and accelerates substance exchange of cells, it increases DNK and RNK synthesis and stimulates cells division, which cause quicker regeneration of epithelia, i.e., it accelerates the process of wound healing. CONCLUSION: It can be concluded that small power laser can be used successfully as additional method of treatment, after closing of oroantral communication surgically.

A review of oro-antral communications.

Oro-antral communications are occasionally produced during routine oral surgery procedures and often cannot be avoided. Dentistry's emphasis on implantology means that defects in the maxillary sinus are encountered far more frequently than before; therefore, knowledge of the maxillary sinus is of the utmost importance. Unfortunately, many general dentists have not been trained to provide proper treatment to correct these defects. Swift diagnosis and subsequent treatment are vital to proper and successful management. This article reviews the literature and the anatomy of the maxillary sinus and discusses the diagnosis and conservative treatment of oro-antral communications.

Failures in endoscopic surgery of the maxillary sinus.

OBJECTIVE: To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps. STUDY DESIGN: Prospective. SETTING: Tertiary referral center. METHODS: A total of 411 patients were operated on for maxillary chronic rhinosinusitis without nasal polyps (307 rhinogenic rhinosinusitis, 74 odontogenic rhinosinusitis, and 30 oroantral fistula cases) in a single institution between 2002 and 2007. Ten parameters were analyzed to study their relationship with recurrence: etiology of rhinosinusitis, partial resection of middle turbinate, smoking history, allergy, asthma, gastroesophageal reflux, preoperative endoscopic score, CT stage, maxillary sinus mucosa score, and bleeding score. Preoperative characteristics and recurrence rates were compared with the analysis of variance test. Failure was analyzed as a time-dependent variable by the Kaplan-Meier method. Variables identified on univariate analysis were entered into a multivariate Cox proportional hazards model. RESULTS: Recurrent rhinosinusitis developed in 28 (6.8%) cases. In the univariate analysis, preoperative endoscopic score, CT stage, and bleeding score were associated with recidivism. However, the multivariate analysis suggested that only bleeding is an independent predictive factor of recurrence (P = 0.034, 95% confidence interval for odds ratio 0.92-7.21). CONCLUSION: Intraoperative bleeding may be a risk factor for failure in endoscopic surgery of maxillary rhinosinusitis, but there is substantial uncertainty and future research is needed.

Intranasal abuse of prescription hydrocodone/acetaminophen results in oronasal fistula: a case report.

Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. The authors describe the case report of a young woman with chronic back pain and intranasal abuse of prescribed hydrocodone/acetaminophen who was diagnosed after presenting for hypernasal speech and foreign body in the nose. This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.

Oronasal fistula in a 53-year-old hippopotamus (Hippopotamus amphibius).

An oronasal fistula is described in a 53-year-old captive hippopotamus, the animal having shown a nasal discharge, consisting mainly of food particles, during and after feeding for at least 15 years. Necropsy of the emaciated animal revealed an oronasal fistula, measuring 4.5 x 3.5 cm, adjacent to the third left molar tooth, the first and second molars being missing. The fistula was thought to have been caused by an earlier necrotizing alveolitis and osteitis. There was no evidence of rhinitis or aspiration pneumonia. Unrelated findings consisted of a follicular thyroid adenoma and generalized muscle atrophy.

Clinical applications of autologous cryoplatelet gel for the reconstruction of the maxillary sinus. A new approach for the treatment of chronic oro-sinusal fistula.

The authors report their clinical experience regarding an original method of surgical repair of oro-sinusal communications. From September 1999 to December 2003, 13 patients (7 male and 6 female patients; mean age: 52 years, range: 24-68 years) underwent surgical repair of an oro-antral fistula by means of cryoplatelet gel: in three patients, it was mixed with bioglass granules; in two, it was mixed with Bioss; in three, it was mixed with particulate bone extracted by means of a bone grafter from the oral cavity close to the operative site, with addition of demineralised bovine bone; in three, it was used together with porose hydroxyapatite, and in two patients the cryoplatelet gel was used only. No postoperative complication was reported; primary wound healing was achieved within seven to nine days. A bony orthopantoscintigraphy was performed a few months following the operative procedure, showing an active osteogenic process. In eight patients, a CT was performed after 8 to 12 months from the operation, showing a normal pneumatization with reconstruction of the floor of the maxillary sinus. Although preliminary, these findings seem to suggest that the use of bioengineered materials coupled with growth factors and osteoprogenitor cells may represent a valuable alternative to autologous bone transplantation for the reconstruction of the maxillary sinus.

Levator labii superioris muscle transposition to treat oromaxillary sinus fistula in three horses.

OBJECTIVE: To describe surgical transposition of the levator labii superioris muscle to treat oromaxillary sinus fistula in horses. STUDY DESIGN: Clinical study. ANIMALS: Three horses with chronic oromaxillary sinus fistula. METHODS: After severing its tendinous insertion, the muscle belly of the levator labii superioris muscle was retracted and transposed through the oromaxillary sinus fistula. The tendon exited the oral cavity through a full-thickness buccal incision created adjacent to the oral end of the fistula and was then tunneled subcutaneously in a ventral direction before being anchored by sutures to the cheek tissues. RESULTS: Fistulae healed with few complications and with good cosmetic and functional results. CONCLUSIONS: Oromaxillary sinus fistula associated with molariform tooth loss in horses can be treated successfully by transposition of the levator labii superioris muscle. CLINICAL RELEVANCE: Transposition of the levator labii superioris muscle should be considered for resolution of chronic oromaxillary sinus fistula in horses.

Complications of mandibular brachygnathism in a North African leopard.

A 9-year-old, male North African leopard (Panhtera pardus) presented with mandibular brachygnathism and lingually displaced mandibular canine teeth causing a large left oronasal fistula, rhinitis and nasal discharge, and a right orocutaneous fistula. Surgical closure of the left oronasal defect, bilateral mandibular canine tooth crown reduction, and root canal therapy resulted in a positive clinical outcome. A small recurrent left oronasal fistula and the right orocutaneous fistula healed spontaneously after alleviating the occlusal contact with the mandibular canine teeth. At 12-months postoperatively, clinical signs of oral and dental disease had resolved.

[Status of mucous membrane of the maxillary sinus in patients with oral-sinus interconnection in different terms after its appearance].

The status of anatomy-morphology of maxillary mucosa depending on the time of interconnection between the maxillary sinus and oral cavity, the size of it and its function were studied. The study was conducted on 25 patients and 20 cadavers. Changes in the mucous membrane of the maxillary sinus in relation to some of factors are discussed.

Unusual presentation of nasopharyngeal (juvenile) angiofibroma in a 45 year old female.

Juvenile nasopharyngeal angiofibroma is a rare tumour, comprising 0.05% of the head and neck tumours, histologically benign, locally invasive, and has a specific predilection for nasopharynx and adolescent males. This article presents an unusual case of nasopharyngeal angiofibroma in a 45-year-old female patient, manifesting as a destructive maxillary lesion and discusses the two most important factors regarding this tumour, the etio-pathogenesis and spread.