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Background: Oroantral fistula(OAF), the most common complication after extraction of posterior maxillary teeth leading to chronic maxillary sinusitis, patient discomfort and can cause difficulty in speech, mastication, and overall hygiene of the patient. Many treatment approaches have been developed to treat OAFs; Buccal Fat Pad (BFP) as a graft material, Buccal Advancement flap (BAF) and rotational palatal flap(RPF). Aim: To compare two treatment modalities for the management of Oroantral Fistula (OAF). We compared the clinical outcomes for both Buccal Fat Pad (BFP) reinforce Buccal Advancement flap(BAF) and rotational palatal flap (RPF) treatment approaches. Material and Methods: A total of 76 patients were included in this randomized controlled clinical study and were divided into two groups; Group A: treated with BFP reinforce BAF, and Group B: treated with RPF. Both procedures were performed under local anesthesia. All the patients were assessed clinically by Valsalva test at 1 week and 4 weeks post-surgicalwhere the surgical siteswere examined by direct visual examination for the amount of both epithelization and closure of the OAF. Results: Our results showed no statistical significant difference (P>0.05) in the clinical outcomes of for both tested OAF treatments Conclusion: Both treatment approaches are good and dependable inthe management of OAF.

BACKGROUND Search of the English literature yielded no studies assessing the chosen dental treatment following surgical closure of oroantral communication/oroantral fistula (OAC/OAF). The purpose of the present study was to assess factors affecting the decision to rehabilitate the posterior maxilla following surgical closure of OAC/OAF. METHODS Consecutive patients at a single center. A structured form served to collect the data. The differences between groups (cases with versus cases without restoration) were assessed statistically. RESULTS A total of 58/121 responding individuals (62.1% men). Average age 51.57 years. Average waiting time prior to restoration 10.34 months. Most (51.7%) healthy. Most had a dental etiology (60.3%). Thirty-nine (67.2%) patients had a restoration of the posterior maxilla. Most of the patients responded that the reason not to do any restoration is the fear of failure (65.5%). Most of the patients completed the restoration procedure in a private clinic (87.2%). Only one patient (2.6%) reported a complication. Approximately half of the patients had implant supported prosthesis (ISP) following sinus augmentation (48.3%) with delayed implant placement. Most of the patients responded that the reason not to have ISP was the fear of failure (72.7%), and the rest responded because of financial issues (27.3%). For tooth supported restoration, most of the patients responded removable (90.9%). CONCLUSIONS Surgeons generally wait 6-12 months following surgical treatment of OAC/OAF prior to reconstruction with ISP. The chance for complications is low. Healthy women after dental induced OAC/OAF have the highest chances to seek for ISP in such circumstances.

To explore the efficacy and value of personalized surgical schemes in the repair of maxillary sinus perforation and maxillary sinus fistula based on the size of the maxillary sinus perforation and maxillary sinus fistula. A total of 28 patients with maxillary sinus perforation and maxillary sinus fistula who were admitted to the Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Kunming Medical University from July 2017 to May 2020 were included to conduct a prospective case clinical study. After the inflammation in the maxillary sinus was controlled, a proper surgical repair method was selected according to the size of the perforation and fistula based on the double-layer closure technique. The diameter of the perforation and fistula was measured with the assistance of cone-beam CT. After that, the platelet rich fibrin (PRF) repair was performed on the perforation and fistula with 3 mm≤diameter7 mm in size in 14 patients. The PRF repair and buccal flap repair were performed on the perforation and fistula with 7 mm ≤diameter15 mm in size in 7 patients. The adjacent buccal pad repair, palatine flap repair, and buccal flap repair were performed on the perforation and fistula with 15 mm≤ diameter25 mm in size in 4 patients. The nasolabial axial flap repair and nasolabial free flap repair were performed on the perforation and fistula with a diameter ≥25 mm in size in 3 patients. The medical follow-up was conducted in all patients in the 1st, 2nd, and 4th week after surgery, with an overall success rate reaching 96.4% (27/28) after the initial intervention. The relapse of disease occurred in one patient (4.6%) with diabetes and a smoking history in the 2nd week after surgery. Identifying a proper surgical repair method according to the size of the oral and maxillary sinus perforation and maxillary sinus fistula based on the double-layer closure technique can improve the one-time cure rate in these patients under the premise that the inflammation in the maxillary sinus can be controlled.根据患者上颌窦穿孔及上颌窦瘘孔大小，选择个性化手术方案，探索在口腔上颌窦穿孔及上颌窦瘘修复中的应用疗效和意义。纳入2017年7月至2020年5月就诊于昆明医科大学附属口腔医院口腔颌面外科的口腔上颌窦穿孔及上颌窦瘘患者28例，进行前瞻性病例临床研究。在保证上颌窦内炎症得以控制的情况下，以双层封闭技术为核心，根据穿孔及瘘孔的大小选择相应的手术修复方法。通过锥形束CT测量穿孔和瘘孔直径大小，对直径≥3 mm且7 mm的14例患者，采用富血小板纤维蛋白（platelet rich fibrin，PRF）填充修复法；对直径≥7 mm且15 mm 的7例患者，采用PRF+颊侧组织瓣修复方法；对直径≥15 mm且25 mm的4例患者，采用邻位颊脂垫组织瓣+腭侧组织瓣+颊侧组织瓣重叠修复法；对直径≥25 mm的3例患者，采用鼻唇沟轴型皮瓣或鼻唇沟任意皮瓣修复法。所有患者在术后第1、2、4周随访检查，初次干预后总成功率为96.4%（27/28）；1例（4.6%）患者术后第2周复发。在保证上颌窦内炎症得以控制的情况下，以双层封闭技术为核心，根据穿孔及瘘孔的大小程度选择相应的手术修复方法，可提高口腔与上颌窦穿孔及上颌窦瘘的一次性治愈率。.

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.

Odontogenic maxillary sinusitis (OMS) is a well-recognized condition in both the dental and otolaryngology communities. Close to 30% of cases of unilateral maxillary sinusitis may have an underlying dental pathology. Failure to identify a dental cause usually lead to cases recalcitrant sinusitis often associated with serious complications. The aim of this study is to describe the literature findings on odontogenic maxillary sinusitis that discuss anatomy, epidemiology, etiology, bacteriology, diagnosis and treatment. The present review is based on a current search using bibliographic database and academic search engine. All the articles on odontogenic maxillary sinusitis published after 2000 were included. This study seeks to provide clinicians with evidence that motivates a comprehensive approach to the evaluation and management of OMS. Controversies on diagnosis and management have been addressed and data from different treatment plans were collected by exploring relevant publications. The surgical treatment of OMS is based essentially on the dental surgery, combined with endoscopic sinus surgery, in order to completely remove the infection, restore the physiological drainage of the sinus and prevent recurrences of sinusitis. A multidisciplinary otolaryngology and dental team is mandatory to successfully manage the dental pathology and the complications resulting from the dental treatments.

Oroantral communication (OAC) is a pathological communication between the oral cavity and the maxillary sinus. Numerous methods are described to manage an acute OAC with some adverse effect and limitations. Our comparative cross-sectional study tried to evaluate the efficacy of Platelet-rich fibrin (PRF) by comparing with the Buccal advancement flap for the closure of acute OAC on 38 patients (n=38), were divided into two groups. One group treated by traditional Buccal advancement flap and compared with the group treated with PRF clot and membranes. Statistically significant better healing with less complication was observed (P< 0.05) in group treated with PRF clot and membranes considering as an effective way to manage acute oroantral communications.

OBJECTIVES Assess the unique clinical and radiological sequelae following oro-antral communications/fistulae (OAC/OAF) due to implant dentistry vs other etiologies. MATERIALS AND METHODS A structured form served to collect data from medical records. All consecutive patients who underwent surgical closure of OACs/OAFs between 2003 and 2020, at a single center were included. Demographic, radiological, clinical, operative and postoperative characteristics were collected. The differences between groups (cases with implant dentistry etiology [IDE] vs cases with other etiologies) were assessed statistically. RESULTS Data were gathered from 121 cases. The findings show that IDE cases were more likely to be of older age (OR = 1.07, CI [1.02, 1.13] P = .02); to have a foreign body in the maxillary sinus (OR = 21.04, CI [4.34, 114.92] P

Purpose The aim of the present study was to increase awareness of an underreported surgical complication by presenting the relevant findings of cases of herniated oroantral sinonasal polyp (OASNP) identified from our biopsy service and from previously reported cases. Materials and Methods The present study was a retrospective descriptive case series with a review of the reported data. Cases of OASNP were identified from our biopsy service, and the clinical, radiographic, surgical, and demographic information was retrieved. Previously reported cases of OASNP were also reviewed. Results We identified 14 cases of OASNP in our biopsy service and an additional 10 reported cases. Overall, OASNP was more prevalent in males (71%). The age range was 19 to 85 years (overall mean, 46.6 years; median, 43.5 years). OASNP typically presented as a red polypoid mass that was frequently pedunculated with a smooth or granular surface. The lesions were located on the maxillary alveolus in the molar region. The most commonly implicated tooth was a maxillary first molar (74%). In some cases, the OASNP had been mistaken for a tumor or pyogenic granuloma. Almost all were at least 1 cm in the greatest dimension, with 43% measuring at least 2 cm in size, and 1 lesion reaching 5 cm in diameter. The reported period for development of the lesion ranged from 2 days to 5 years, with 60% developing within 2 months of the extraction. All lesions had undergone surgical excision. Antibiotic use and surgical closure of the oroantral communication had been described for some of the cases. Conclusions The results from our study suggest that herniation of a sinonasal polyp through an oroantral defect could be an underreported complication of maxillary exodontia. Additional research would help to enhance our knowledge and understanding of this interesting condition.

Odontogenic cutaneous fistula of dental origin at the alar-facial groove is rarely reported. As many patients present with only skin lesions without dental problems, it is often confused with a cyst, abscess or pyogenic granuloma. We report the case of a 52-year-old man who presented with a relapsing cutaneous ulcer in the left alar-facial groove area. Ultrasonography findings suggested a ruptured epidermal cyst, and an excisional biopsy was performed. At 10 days after the surgery, wound dehiscence and pus discharge were observed. Computed tomography revealed a sinus tract, and a diagnosis of odontogenic cutaneous fistula was made. After consultation with the dental department, endodontic treatment was performed. During reoperation, a remnant fistula from the left alar-facial groove area to the left upper central incisor was observed, for which fistulectomy was performed. The patient remained disease-free postoperatively. With early accurate diagnosis, patients with odontogenic cutaneous fistula can be protected from unnecessary surgical intervention and ineffective antibiotic therapy.

BACKGROUND: Oroantral fistula (OAF) is a pathological communication between maxillary sinus and oral cavity, which treated by various surgical methods including buccal flap and associated with post-operative discomfort and relatively long healing period. AIM: The objective of the study was to evaluate the effect of 0.2% hyaluronic acid (HA) gel on the healing period after surgical buccal flap treatment of OAF. METHODS: The records of 20 patients of both genders included and reviewed retrospectively. Ten patients treated with topical 0.2% HA gel while the other 10 patients treated without it. Patients healing process followed up for suture removal appointment. RESULTS: Statistically significant p ≤ 0.05 decreases in healing period when we compare patients treated with topical HA gel and those without topical HA gel. CONCLUSION: The use of topical HA gel may have advantages for soft-tissue healing and decrease healing period for patients has OAF treated with surgical buccal flap.

Maxillary sinus membrane perforation commonly occurs during extraction, mostly during an impacted tooth extraction. If left untreated, maxillary sinus perforation can cause several complications. Here, we describe a closure technique of an oroantral fistula using a bone fragment. During the extraction of an impacted maxillary second premolar, the tooth fell into the maxillary sinus. The tooth was removed from the sinus using a transantral approach. A bone fragment of the tooth was obtained and placed in the extraction socket via the transantral entrance and fixed with fibrin glue (Greenplast; Green Cross, Yongin, Korea) to close the oroantral fistula. After 5 months, an immature bone was formed in the sealed area where the bone graft was placed, without any complications.

The aims of this study were to find out whether scoring in a rose-trellis pattern improved the stretch of mucoperiosteal flaps more than conventional scoring in the horizontal plane, and to consider its application in the closure of oroantral communications. Sixteen sections of cadaveric porcine buccal mucoperiosteum were removed from the molar region of the maxilla and mandible. A three-sided flap was raised in the subperiosteal plane, excised, and pinned to a cork board with the periosteal side facing upwards. Eight samples were scored in the horizontal plane (control) using lines perpendicular to the line of simulated advancement, and eight in a rose-trellis or criss-cross pattern. Scoring using a rose-trellis pattern yielded a mean increase in stretch of 24.3% (p = 0.0003) when compared with the conventional method. Buccal advancement flaps are widely used to close oroantral communications, and scoring of the mucoperiosteum facilitates the stretching of the tissue over the defect. To be successful, defects should be fully closed to prevent contamination, and closure should be tension-free. In this study, scoring in a rose-trellis pattern increased the stretch of the tissue sample more than scoring in the horizontal plane. The rose-trellis technique therefore could aid the effective closure of oroantral communications.

Highlights • It is a rare case study of a patient suffering from long standing oral cavity idiopathic gingival hyperplasia with maxillary sinus invasion that does not respond to traditional methods of treatment. • In order to restore the function, enhance the cosmetic appearance and quality of life of the patient, surgical intervention is also required to correct the various pathologies affecting the patients. • This paper highlights the surgical method embraced to dispose of the pathology influencing the patient and progressing the generally wellbeing of the persistent. • The management of our patient highlights the need for an early visual recognition and evaluation approach that is multidisciplinary, multi factorial and multi-faceted., Introduction Idiopathic gingival hyperplasia is a rare entity (about one in 1,75,000 individuals). It is characterized by a slow progressive benign enlargement, affecting the attached gingiva, marginal gingiva, and interdental papilla. Presentation of case This case report highlights the management of an unusual case of long standing idiopathic gingival hyperplasia involving the right maxillary sinus. Discussion Management of gingival hyperplasia depends on the severity of the condition. In this case, surgical excision was performed in both the arches, that resulted in the creation of an oroantral communication, which was protected with a prefabricated custom-made acrylic stent. Despite having a visible raw area of epithelialization evident on the 2nd post operative day, there were no significant signs of recurrence even at a follow-up of 2 years post surgery. Many authors advocate extraction of involved teeth, in addition to the gingival excision, in the presumption of a permanent cure. Conclusion The patient was satisfied with the resultant esthetic and functional outcome of the treatment. But, the possibility of recurrence cannot be ruled out, so the patient should be kept under close observation. She may also require subsequent surgeries, thus making psychological counseling mandatory.

The purpose of this study was to determine current practice in assessment of maxillary sinus health during oro-antral fistula closure.A systematic review using specific MeSH headings between 1990 and September 2021 on Medline, Ovid, and PubMed was performed. The inclusion criterion was closure of oro-antral fistula in adult patients. Exclusion criteria were oro-antral fistula arising in children; or from trauma, malignancy, or developmental abnormality; or any osteonecrotic lesion of bone. Risk of bias for individual papers was not assessed. Oxford Centre for Evidence Based Medicine levels of evidence were recorded.4309 papers were identified, and 119 were eligible for review. Nineteen were from otolaryngology (16%), 25 from combined ear, nose, and throat (ENT) and oral/oral and maxillofacial (OS/OMF) surgery (21%), and 75 from OS/OMF surgery (63%). Preoperative rhinoscopy and cross-sectional imaging were reported in 33 papers (28%), reflecting the role of ENT with or without OS/OMFS. Sixty-eight did not record any formal assessment of maxillary sinus health (57%), of which 60 were from OS/OMF surgery (50%). Use of computed tomography was reported in 58 papers (49%), and use of cone beam computed tomography was reported in 8 papers (7%) but did not correlate with assessment of sinus health.Most surgery for oro-antral fistual closure was undertaken without objective assessment of maxillary sinus health, pre- or postoperatively. The involvement of ENT was associated with formal assessment of maxillary sinus health.

INTRODUCTION: Oroantral fistula is an epithelialized, pathological and unnatural communication between the oral cavity and the maxillary sinus. OBJECTIVES: The aim of this study was to evaluate the use of buccal antrostomy bone as a graft for closure of oroantral fistula clinically and radiographically. MATERIALS AND METHODS: A prospective study was done on 10 patients complaining of oroantral fistulae following extraction of maxillary posterior teeth. The bony defect of the oroantral fistula was closed by anterior wall of maxillary sinus as a graft material and fixed to the surrounding bone using N-Butyl-2-Cyanoacrylate (Histoacryl®), then covered by buccal advancement flap. The patients were followed up clinically after 4, 6, 8 and 12 weeks postoperatively Radiographic evaluation was performed by cone beam computed tomography (CBCT) preoperatively and after 12 weeks postoperatively. RESULTS: Evaluation of the patients revealed that proper healing of the wound occurred in most of the patients except in 3 patients whose bone graft was exposed and removed. Radiographicaly, significant amount of bone was formed comparing the preoperative and postoperative CBCT of the patients. CONCLUSIONS: According to the results of the present study, it is concluded that the use of the buccal antrostomy wall as a bone graft fixed with N butyl cyanoacrylate proved successful results in closure of large oroantral fistula.

Diagnosis and management of sinonasal complications of dental diseases or treatment (SCDDT) may be challenging. We aimed to report our real-life experience in patients treated with endoscopic endonasal approach describing data about symptoms, etiology, extension of the disease and success rate. We evaluated retrospectively data about 262 patients diagnosed as SCDDT and managed from August 2015 to May 2022. In 44.65% cases, maxillary sinus complications were determined by a dental disorder; the remaining 55.34% of cases were iatrogenic. Patients were managed according to our multidisciplinary protocol including ENT, dental, and radiological evaluation. Treatments were planned with a personalized approach, based on the patient’s clinical characteristics; all patients were treated with an endonasal endoscopic mini-invasive conservative approach. Combined dental treatment was performed simultaneously in 152/262 (58%) of patients; in the remaining cases, it was postponed after surgery. The overall treatment success rate (symptom resolution and endoscopically observed maxillary sinus healing) was 96.5%. At 15 days after surgery, we observed a significant improvement in the quality of life. The mean post-operative Sinonasal outcome test-22 (SNOT-22) score was significantly lower compared to baseline (6 versus 43.4; p < 0.05). Our study showed that endoscopic sinus surgery can be a successful procedure for treatment of SCDDT, leading to fast resolution of sinonasal symptoms and improving the quality of life. Furthermore, the technique allows removal of migrated dental material or dental implants even in challenging cases.

Background The pedicled buccal fat pad has been used for a long time to reconstruct oral defects due to its ease of flap formation and few complications. Many cases related to reconstruction of defects in the maxilla, such as closing the oroantral fistula, have been reported, but cases related to the reconstruction of defects in the mandible are limited. Under adequate anterior traction, pedicled buccal fat pad can be a reliable and effective method for reconstruction of surgical defects in the posterior mandible. Case presentation This study describes two cases of reconstruction of surgical oral defects in the posterior mandible, all of which were covered by a pedicled buccal fat pad. The size of the flap was sufficient to perfectly close the defect without any tension. Photographic and radiologic imaging showed successful closure of the defects and no problems were noted in the treated area. Conclusion In conclusion, the pedicled buccal fat pad graft is a convenient and reliable method for the reconstruction of surgical defects on the posterior mandible.

Background: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue flaps. An additional Caldwell-Luc approach or endoscopic sinus surgery (ESS) is required to address coexisting maxillary sinusitis.Objectives: This study presents the endonasal closure of an OAF through modified endoscopic medial maxillectomy (MEMM) with a free nasal mucoperichondrial-osteal graft.Materials and methods: Sixteen OAF patients who underwent closure operations in our department from May 2013 to June 2018 were retrospectively reviewed.Results: The main cause of OAF was maxillary dental cysts (56.25%). The OAF size ranged from 2 × 2 to 10 × 15 mm. The first molar (62.5%) was the most frequently involved tooth. All closures were made via MEMM, using nasal mucoperichondrial-osteal grafts harvested from the septum or nasal base. All patients were followed up for at least six months. Successful closure after a single procedure was achieved i...

The aim of this study was to compare the clinical outcomes of buccal advancement flap surgery to platelet-rich fibrin (PRF) application for the closure of acute oroantral communications (AOACs). In 36 patients, following the extractions of posterior maxillary teeth, AOACs which were larger than 3 mm diameter were detected. In group A, PRF clots were used in 21 patients and group B, classic buccal advancement flap was used in 15 patients. Baseline variables such as pain, the analgesic doses are taken, and swelling was assessed preoperatively. These were also examined on postoperative days 1, 2, 3, and 7, and patients were seen again in the 3rd week. In group A, statistically significant reduction was examined (P 0.05) in pain and the analgesic doses are taken (sum of 1st, 2nd, 3rd, and 7th days on days 1 and 2) (PRF). The swelling was also significantly less in group A (P 0.05). The mean duration did not differ between the groups (P 0.05). In conclusion, both methods were successful for the immediate closure of AOACs. However, a lesser amount of pain and no swelling observed with the use of PRF clots for the immediate closure of AOACs compared to buccal advancement flap surgery.

Background: Odontogenic sinusitis (ODS) is frequently encountered in ENT practice, however, there are no guidelines regarding its management. This study aims to analyse the results of endoscopic sinus surgery versus dental treatment in ODS. Additionally, we aim to demonstrate the benefit of associating endoscopic sinus surgery (ESS) to surgical closure of chronic oroantral fistulas (OAF) by comparing mean time to healing in patients who opted or not for concurrent ESS. Methods: Records of patients with ODS were reviewed. Group one consisted of patients with ODS caused by periapical pathology undergoing either endoscopic sinus surgery (ESS) or dental treatment. Resolution of ODS was considered treatment success and was compared between the two treatment strategies. Group two included patients with ODS and associated chronic oroantral communication. Time to healing was compared between patients undergoing OAF closure alone versus patients receiving associated ESS, using the Log-Rank test to correlate Kaplan–Meier curves. Results: 25 patients from a total of 45 in group one underwent dental treatment alone, and 20 opted for exclusive ESS treatment. The failure rate was 40% for patients treated with ESS compared to 4% (one patient) for dental treatment. ODS resolved in all patients in the second group, but the mean time to healing was half (10 days) when ESS was complementary to OAF closure. Conclusion: The present study represents the first estimator of the role ESS plays in OAF treatment. Nonetheless, it provides proof of the importance of first addressing dental problems in odontogenic sinusitis.

Oroantral fistula is a pathological and epithelised communication between pseudo stratified columnar ciliated epithelium of maxillary antrum and squamous epithelium of oral mucosa. Various techniques in literature point to the fact that repair of oroantral fistula is one of the most challenging problems in oral and maxillofacial surgery. Buccal advancement flap technique causes vestibular shortening, reduction in keratinized gingiva width with closure under tension thereby increasing the chances of wound dehiscence. On the other hand, Inverted periosteal flap preserves vestibular depth, maintains keratinized gingiva width providing true tension free closure. However, it is technically very challenging with maximum chances of perforation of delicate periosteal flap. A new Modified Inverted Periosteal Flap technique for oroantral fistula repair will eliminate all the potential complications and adverse effects of both the conventional buccal advancement flap and inverted periosteal flap procedures providing a true ideal closure.

Purpose An oroantral communication (OAC) is an abnormal space between the maxillary sinus and oral cavity. The causes, complications, treatment, and radiographic features of OAC in 2-dimensional and 3-dimensional imaging modalities are discussed. Materials and Methods This pictorial review presents a broad spectrum of imaging findings of OAC. Representative radiographs depicting OAC were chosen from our database. PubMed was used to conduct a comprehensive literature search of OAC. Results Characteristic features of OAC include discontinuity of the maxillary sinus floor, thickening of the maxillary sinus mucosa, or a combination of both. Two-dimensional imaging modalities are the method of choice for identifying discontinuities in the maxillary sinus floor. However, 3-dimensional imaging modalities are also essential for determining the status of soft tissue in the maxillary sinus. Conclusion The integration of 2-dimensional and 3-dimensional imaging modalities is crucial for the correct diagnosis and comprehensive treatment of OAC. However, the diagnosis of OAC must be confirmed clinically to prevent unnecessary mental and financial burdens to patients.

Routine exodontia is a common procedure performed by the general dental practitioner and the oral surgeon alike. Most of the maxillary premolar/molar extractions heal uneventfully, but some may cause inadvertent opening into the maxillary sinus, manifesting as immediate oroantral communications (OACs) or delayed oroantral fistulae. The common reasons being difficulty encountered in the extractions intra-operatively due to myriads of reasons or the OAC may be due to a pre-existing pathology in the periapical region or within the sinus lining. Whatever the reason be, it is paramount that the surgeon identifies the problem and approaches it in a sequential manner to avoid long-term consequences and to attain a perfect closure. The timing of the closure is crucial, which is dependent upon the sinus health and the socket condition. This may be complicated by a missing root tip, which is lying in the sinus. This chapter aims to walk the reader through these events in a logical fashion so that they can take appropriate decisions and use the correct surgical technique, which will ensure successful closure of the defect.

The objective of this study was to analyze the outcome of first-time surgical closures of oroantral communications (OAC) after tooth extractions. Using a billing software, all patients treated in a surgery department were filtered for interventions of the maxillary sinus indicative of OAC therapy. Out of 221 initially eligible cases, the charts of 162 cases fulfilling the inclusion criteria were retrospectively evaluated for the outcome in terms of symptom-free OAC closure as well as possibly influencing patient and treatment factors. The analyzed cohort included 98 males (60.5%) and 64 females (39.5%) with a mean age of 48.6 years (range 17 to 86 years). The maxillary 1st molar (38.3%) was the most common site requiring OAC closure. In 60.5% of the cases, surgical OAC closure was performed immediately after tooth extraction. The Rehrmann flap (72.2%) was the most frequently used technique for surgical OAC closure. 94.4% of surgical OAC closures were successful. Gender and age did not influence the outcome. In contrast, the site of OAC and the time interval from tooth extraction to OAC closure affected the results. Furthermore, the Rehrmann flap, alone or in combination with biomaterials, was superior to the mere suturing (with or without biomaterials) of the OAC site. In conclusion, the Rehrmann flap alone or in combination with biomaterials provided high success rates for first-time surgical OAC closure. With regard to the study parameters, an OAC in the 3rd molar area and an extended interval from tooth extraction to OAC closure negatively influenced the resolution of OAC. However, results must be interpreted cautiously considering the retrospective study design and the limited number of cases.

Oro-antral communications/fistulae (OAC/OAF) can cause significant patient morbidity, with treatment for defects greater than 5mm in size requiring surgical reconstruction. This technical note evaluates the effectiveness, and proposes the use of, the temporal extension of the buccal fat pad (TEBFP) for the closure of large OAC. The TEBFP can be an effective means of large OAC closure due to its ease of harvesting, with minimal damage to surrounding structures or aesthetic changes. The use of the TEBFP provides stability, versatility, and tension-free closure, with minimal postoperative complications.

A comunicação bucosinusal trata-se da comunicação não natural da cavidade bucal com o seio maxilar, estando muitas vezes relacionada a extração dos dentes superiores posteriores. A literatura apresenta diversas opções de tratamento para esses casos, entre eles o fechamento com o retalho pediculado com o corpo adiposo bucal. O objetivo deste trabalho foi relatar um caso de fístula bucosinusal em paciente diabético, discutindo alternativas cirúrgicas correlacionadas com problema sistêmico do paciente e características locais do defeito. Paciente do sexo masculino, 55 anos de idade, com histórico de dez dias de exodontia do elemento 27, com queixa de passagem de ar ao meio bucal através do sítio cirúrgico. Com base nos exames, o diagnóstico definitivo foi de comunicação bucosinusal, sendo estipulado o tratamento cirúrgico para o fechamento da comunicação através de duas camadas com o corpo adiposo da bochecha seguido do retalho vestibular. No acompanhamento de 8 meses e meio o paciente não apresenta queixas e pode-se observar o fechamento completo da comunicação bucosinusal. O retalho pediculado do corpo adiposo bucal seguido do retalho vestibular mostrou-se efetivo no tratamento da fístula bucosinusal em paciente diabético controlado.Descritores: Fístula Bucoantral; Cirurgia Bucal; Diabetes Mellitus.ReferênciasLozano-Carrascal N, Salomó-Coll O, Gehrke SA, Calvo-Guirado JL, Hernández-Alfaro F, Gargallo-Albiol J. Radiological evaluation of maxillary sinus anatomy: A cross-sectional study of 300 patients. Ann Anat. 2017;214:1-8.Jang JK, Kwak SW, Ha JH, Kim HC. Anatomical relationship of maxillary posterior teeth with the sinus floor and buccal cortex. J Oral Rehabil. 2017;44(8):617-25. Khandelwal P, Hajira N. Management of Oro-antral Communication and Fistula: Various Surgical Options. World J Plast Surg. 2017;6(1):3-8.Parvini P, Obreja K, Begic A, et al. Decision-making in closure of oroantral communication and fistula. Int J Implant Dent. 2019;5(1):13.Lin PT, Bukachevsky R, Blake M. Management of odontogenic sinusitis with persistent oro-antral fistula. Ear Nose Throat J. 1991;70(8):488-90.Al-Juboori MJ, Al-Attas MA, Magno Filho LC. Treatment of chronic oroantral fistula with platelet-rich fibrin clot and collagen membrane: a case report. Clin Cosmet Investig Dent. 2018; 10:245-49.Kiran Kumar Krishanappa S, Eachempati P, Kumbargere Nagraj S, Shetty NY, Moe S, Aggarwal H et al. Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane Database Syst Rev. 2018;8(8):CD011784. Darr A, Jolly K, Martin T, Monaghan A, Grime P, Isles M et al. Three-layered technique to repair an oroantral fistula using a posterior-pedicled inferior turbinate, buccal fat pad, and buccal mucosal advancement flap. Br J Oral Maxillofac Surg. 2018;56(7):638-39.Parvini P, Obreja K, Sader R, Becker J, Schwarz F, Salti L. Surgical options in oroantral fistula management: a narrative review. Int J Implant Dent. 2018;4(1):40. Lin PT, Bukachevsky R, Blake M. Management of odontogenic sinusitis with persistent oro-antral fistula. Ear Nose Throat J. 1991;70(8):488-90.Borgonovo AE, Berardinelli FV, Favale M, Maiorana C. Surgical options in oroantral fistula treatment. Open Dent J. 2012;6:94-8.Ribeiro FS, de Toledo CT, Aleixo MR, Durigan MC, Silva WC, Bueno SK et al. Treatment of Oroantral Communication Using the Lateral Palatal Sliding Flap Technique. Case Rep Med. 2015;2015:730623.Erdoğan O, Esen E, Ustün Y. Bony palatal necrosis in a diabetic patient secondary to palatal rotational flap. J Diabetes Complications. 2005;19(6):364-67.Tideman H, Bosanquet A, Scott J. Use of the buccal fat pad as a pedicled graft. J Oral Maxillofac Surg. 1986;44(6):435-40.Yang S, Jee YJ, Ryu DM. Reconstruction of large oroantral defects using a pedicled buccal fat pad. Maxillofac Plast Reconstr Surg. 2018; 40(1):7.Raldi FV, Sardinha SCS, Albergaria-Barbosa JR. Fechamento de comunicação bucossinusal usando enxerto pediculado com corpo adiposo bucal. BCI. 2000;7(25):60-3.Poeschl PW, Baumann A, Russmueller G, Poeschl E, Klug C, Ewers R. Closure of oroantral communications with Bichat's buccal fat pad. J Oral Maxillofac Surg. 2009;67(7):1460-66.Batra H, Jindal G, Kaur S. Evaluation of different treatment modalities for closure of oro-antral communications and formulation of a rational approach. J Maxillofac Oral Surg. 2010;9(1):13-8. Weinstock RJ, Nikoyan L, Dym H. Composite three-layer closure of oral antral communication with 10 months follow-up-a case study. J Oral Maxillofac Surg. 2014;72(2):266.e1-266.e2667.Candamourty R, Jain MK, Sankar K, Babu MR. Double-layered closure of oroantral fistula using buccal fat pad and buccal advancement flap. J Nat Sci Biol Med. 2012;3(2):203-5.

Purpose In maxillary wisdom tooth extraction, the necessity of CT is unknown. The purpose of this study was to investigate whether CT adding to orthopantomography is useful for predicting oroantral perforation during maxillary third molar extraction. Methods Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analyses. We analyzed those of all patients and the patients who underwent CT, respectively. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) and Archer classification were assessed using panoramic radiography. The number of roots and vertical relationship were assessed using CT. Results A total of 604 out of 3299 patients underwent CT adding to orthopantomography. In all cases, multivariate analyses except for CT findings showed that the RS classification type III/IV and the Archer classification Type B/C/D in panoramic findings were significantly correlated with oroantral perforation as radiological findings. In cases for which CT was performed, multivariate analyses showed that one root (OR 12.87) and the vertical relationship Type D (OR 5.63) in CT findings, besides the RS classification type III/IV (OR 4.47) in panoramic findings, were significantly related to oroantral perforation. Conclusion The RS classification and the Archer classification in panoramic findings can predict the risk of oroantral perforation. The usefulness of CT adding to orthopantomography is limited. However, when the relationship between the upper wisdom tooth and maxillary sinus floor (RS classification) is unclear, to check whether the number of roots is one and the apex of one root is projecting into the maxillary sinus in CT findings, is useful for the prediction.

Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with combined surgical approach for chronic maxillary sinusitis of dental origin due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of a normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.

The prevalence of oronasal and oroantral fistulas (ONF/OAF) was retrospectively identified in a population of dachshund patients (dachshund group) and was compared to a population of small breed dogs of significantly similar age and weight (control group). When compared with the control group, the dachshund group was significantly more likely to have an ONF/OAF ( P < .0001). The odds ratio indicates that dachshunds were 3.3 times more likely to have an ONF/OAF than individuals within the control group. This study statistically confirms previous reports and clinical observations that dachshunds are predisposed to ONF/OAFs. When ONF/OAFs are present, the maxillary canines are the most commonly affected dentition in both study groups.

Resumo O desenvolvimento de uma fistula bucossinusal, a partir de uma comunicacao gerada entre a cavidade oral e o seio maxilar, pode ser favorecido por um nao fechamento espontâneo ou por uma sinusite maxilar cronica ja instalada. O tratamento da fistula bucossinusal depende de fatores que podem beneficiar ou dificultar o prognostico dos casos, como a localizacao, causa e o tamanho do defeito gerado. Diferentes tecnicas sao descritas na literatura para o tratamento destes defeitos orosinusais, como retalhos locais deslizantes ou rotacionados, enxertos autogenos ou o uso da bola de gordura bucal. O objetivo do presente trabalho e apresentar o caso clinico de uma fistula bucossinusal pos exodontia ha aproximadamente 05 anos, nao corrigida imediatamente, tratada atraves de retalho mucoso palatino rotacionado. Como coadjuvante para a cicatrizacao da area doadora foi utilizado membrana de fibrina rica em plaquetas. A tecnica do retalho palatino mostrou-se uma opcao favoravel para o fechamento da fistula bucossinusal e o uso dos fatores de crescimento permitiu vascularizacao adequada na area doadora e no retalho rotacionado, o que favoreceu a hemostasia vascular e estimulou a recuperacao dos tecidos moles adjacentes. Palavras-chave: Seio maxilar, fistula bucoantral, cirurgia bucal, fibrina rica em plaquetas. Abstract The development of a bucosinusal fistula from a communication generated between the oral and maxillary cavity may be favored by a spontaneous unblocked or an existing chronic maxillary sinusitis. The treatment of bucosinusal fistula depends on factors that may benefit or hinder the prognosis of cases, such as location, cause and size of the defect used. Different techniques are described in the literature for the treatment of these oral defects, such as sliding or rotating local flaps, autogenous grafts or the use of the buccal fat ball. The aim of the present study is to present the clinical case of a post-extraction bucosinusal fistula approximately 05 years ago, not immediately corrected, treated through a rotated palatal mucosal flap. As an adjunct to the healing of the donor area, a platelet-rich fibrin membrane was used. The palatal flap technique proved to be a favorable option for the closure of the bucosinusal fistula and the use of growth factors allowed adequate vascularization in the donor area and in the rotated flap, which favored vascular hemostasis and stimulated the recovery of adjacent soft tissues. Key-words: Maxillary sinus, oroantral fistula, oral surgery, platelet-rich fibrin

The aim of this study is to determine the type, frequency, and location of incidental findings in the maxillofacial region in patients undergoing cone beam computed tomography (CBCT) scan for implant treatment.In this study, 300 patients who underwent CBCT imaging for implant treatment planning were evaluated retrospectively. Patients were evaluated in four different categories, namely, maxillary sinus pathologies, temporomandibular joint (TMJ) findings, dentoalveolar findings, and soft-tissue calcifications. In maxillary sinus pathologies, we categorized patients by mucosal thickening, polypoidal lesion, air-liquid level, total opacification, oroantral fistula, periapical lesion related with maxillary sinus, antrolith, hypoplasia, and foreign body presence. In the TMJ findings category, we evaluated patients for erosion, osteophyte, sclerosis, flattening, and bifid condyle. For dentoalveolar findings, we looked for the residual root and impacted tooth. In soft-tissue calcifications, we examined patients for tonsillolith, sialolith, lymph node calcification, styloid ligament calcification, carotid artery calcifications, and osteoma cutis.Mucosal thickening was mostly seen in maxillary sinus pathology. One hundred and forty-eight (49.3%) of the patients had at least one TMJ incidental finding. We detected at least one impacted tooth in 17 (5.7%) patients' maxilla and 14 (4.7%) patients' mandibles. The most frequently seen calcification was styloid ligament calcification. There was no statistically significant relationship between the age groups and incidental findings (P0.05).Oral radiologists should be aware of incidental findings and evaluate the possibilities of underlying diseases in a comprehensive way, and if there is a concern about the finding, they should refer the patient to the relevant specialist.

Oroantral fistulas (OAF), which develop as a result of maxillary sinus infection caused by oroantral communication, are sometimes intractable. We present a case of closure with a facial artery musculomucosal flap (FAMM flap) for intractable OAF. A 73-year-old man presenting with an OAF and rhinorrhea was referred to our department. Twenty-eight years earlier, he had undergone bilateral radical surgery for maxillary sinusitis, and six years earlier, he underwent extraction of his right maxillary first and second molars. Six months after the dental extractions, he developed maxillary sinusitis secondary to oroantral communication. Four years after the dental extractions, he underwent endoscopic sinus surgery with closure of the OAF with a rotational pedicled palatal flap, but the OAF recurred. To treat the OAF recurrence, we used a FAMM flap. His postoperative course was good, with no OAF recurrence 6 years after surgery. FAMM flaps are useful to close intractable OAFs.

Buccal fat pad is much underutilized graft in oral and maxillofacial surgeries. Although, it has been recognized in early seventeenth century, but its use in different conditions as a graft was popularized after mid eighteenth. This article encompasses various aspects of buccal fat pad including its anatomy, development, clinical significance and uses as a graft in much reconstructive procedures in oral and maxillofacial surgery cases e.g. Oroantral fistula, oral sub-mucous fibrosis, resections, reconstructions cases.

Purpose of review To give an overview of technical considerations and relevant literature in the management odontogenic pathology with involvement of the maxillary sinus. Recent findings Infections, cysts, benign neoplasms (odontogenic and nonodontogenic), and inflammatory conditions impact the maxillary sinus in various ways, could result in significant expansion within the maxillary sinus and significant infections. Summary This manuscript provides an overview of common pathologic entities of the oral cavity proper that impacts the maxillary sinus health, with discussion of the role of the otorhinolaryngologist and the dental specialist.

Resumo A fistula ou comunicacao bucossinusal consiste na formacao de um trajeto direto entre a cavidade oral e o seio maxilar diagnosticada tardiamente apos epitelizacao da mucosa formando um canal bucossinusal permanente. Na maioria das vezes, essa complicacao ocorre em funcao da relacao anatomica do seio maxilar intimamente relacionado com o apice das raizes dos dentes superiores posteriores. Procedimentos cirurgicos inadequados relacionados a exodontia dos elementos dentarios envolvidos ou extensa pneumatizacao do seio maxilar podem ser as causas mais comuns dessa patologia. O objetivo do presente trabalho e apresentar um relato de caso clinico de uma fistula bucossinusal pos exodontia e nao corrigida imediatamente, tratada atraves de retalho mucoso palatino vascularizado e rotacionado para fechamento primario. A tecnica do retalho palatino mostrou-se uma opcao favoravel para o fechamento do defeito sinusal em um unico tempo cirurgico, preservando a mucosa queratinizada e a anatomia do sulco vestibular. Palavras-chave: Seio maxilar, sinusite maxilar, fistula bucoantral, cirurgia bucal. Abstract The bucosinusal fistula or communication consists in the formation of a direct path between the oral cavity and the maxillary sinus diagnosed late after epithelialization of the mucosa forming a permanent bucosinusal canal. Most often, this complication occurs due to the anatomical relationship of the maxillary sinus closely related to the apex of the roots of the posterior superior teeth. Inadequate surgical procedures related to the extraction of the involved dental elements or extensive pneumatization of the maxillary sinus may be the most common causes of this pathology. The aim of the present study is to present a case report of an immediately uncorrected post-extraction bucosinusal fistula treated with a vascularized palatine mucous flap and rotated for primary closure. The palatal flap technique proved to be a favorable option for closing the sinus defect in a single surgical time, preserving the keratinized mucosa and the buccal sulcus anatomy. Key-words: Maxillary sinus, maxillary sinusitis, oroantral fistula, oral surgery.

Objective: To report the underlying cause and occurrence of odontogenic disease among patients requiring treatment for chronic maxillary sinusitis in a University Hospital setting in Denmark. Study design: This is a retrospective study including all patients referred for surgical treatment of chronic maxillary sinusitis in the period January 1st, 2000 – December 1st, 2009. All files where reviewed and any concealed odontogenic cause was identified. Demographic data and clinical aspects including duration of illness, radiographic data and prior therapies were assessed. A telephone interview was performed as follow-up. Results: Files from 788 patients treated with surgery for their maxillary sinus disease were evaluated and among 37 patients an odontogenic origin of sinus disease was identified. Of these 81.1% participated in the telephone interview with the majority of patients reporting symptom improvement after the treatment. There were no major complications. The most common cause of odontogenic sinusitis was complication to tooth extraction. Diagnostic delay was common, 32% had experienced symptoms more than a year. Conclusion: According to the conducted survey, 4.7% of patients treated for maxillary sinus disease suffered from an underlying dental disease. In patients with Chronic Rhino Sinusitis (CRS) it is important to gather history of dental disease and prescribe evaluation by a maxillofacial surgeon especially in case of recalcitrant disease.

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.

The incidence of oro-antral communication during removal of maxillary posterior teeth, especially the molars is quite common in general dental practice. The diagnosis and surgical management of oro-antral communication requires the surgical skills including the flap techniques. Here we present the novel technique of immediate closure of oro-antral communication using the PRF in the form of membrane and mixture of PRF and collagen, which is, sandwiched between the PRF membranes for effective management of oro-antral communications which does not require higher surgical skills.

Sinusitis is a recognised rare complication of palatine expansion procedures and is usually caused by the presence of an oroantral fistula. We report the first case of unilateral sinusitis as a result of a retained foreign body (a wooden spatula) following a surgically assisted rapid palatine expansion procedure.