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A total of 276 patients with 314 apicoectomized canines, premolars and molars from the maxilla were reviewed. Oroantral communication (OAC) was noted in 41 (13 %) of the cases. All patients were followed-up clinically and radiographically. The results of the operation proved successful in 54 %, uncertain in 25 % and unsuccessful in 21 %. No difference was found between the results in the OAC group and the rest of the material. The best results were noted for the canines, while the frequency of success was lowest for the first premolars. Such factors as retrograde root filling, the quality of the orthograde root filling, preoperative root resorption and the extent of periapical destruction had no demonstrable effect on the later course. In the group where the periapical lesion was a radicular cyst, the frequency of success was 25 % higher. In four of 26 cases the tomograms showed no bony partition between the apical region and the maxillary sinus. In three of these cases the result was regarded as successful on the basis of conventional radiographs.

One hundred and fifty patients with oroantral communications were examined radiographically and clinically in a prospective study performed in the 4-year period 1968–1972. Radiographically demonstrable pathologic changes of the maxillary sinus mucosal lining were observed in 96 % of cases examined 1–3 days after the closure of oroantral communications. At 3 months postoperatively or later, 85 % of the sinograms were found to be without evidence of radiographic mucosal hyperplasias. Radiographic examination prior to sinus exposure demonstrated pathologic conditions in 36 % of the patients examined. Observations done simultaneously on the ipsilateral side at the different control periods demonstrated a comparatively constant distribution among the different types of radiographic alterations. Bone defects of the maxillary sinus wall in the injured area were found in 7.4 % of the cases examined in standard intraoral radiographs at follow-ups after 3 months or more. The surgical techniques used in this study are discussed in terms of the incidences of failure (3.3 %), gingival remodeling and vestibular sulcus height.

Alveolar defects are seen secondary to congenital and traumatic events. A technique for closure of these defects and associated oronasal fistula is presented. Autogenous iliac crest bone is utilized. Closure of the defect involves closure of the nasal mucosa, implantation of bone, and oral pedicle flaps. Three cases are described as well as some aspects of preoperative and postoperative care.

Summary A case is described of bilateral tuberculous ulceration presenting in the upper molar region of an edentulous patient, which had progressed to give large oroantral fistulae. Careful physical and radiological investigations failed to demonstrate tuberculous lesions elsewhere in this patient, and the source of the disease remains a matter of speculation.

Experimental oro-paranasal communications were established in 11 monkeys (Macaca it-its) through the alveoli of the maxillary first or second molars after extraction of one of these teeth. The morphologic changes of the mucous membrane of the maxillary sinus and adjacent tissues following the experimental trauma were studied. Particular attention was focused on the metaplastic changes of the respiratory epithelium of the injured areas. The observation time ranged from 2 d to 12 weeks. Areas of nonreversible epithelial metaplasia to squamous and cuboid-like nonkeratinized epithelium were observed frequently throughout the observation period in the traumatized region. Mesenchymal cell proliferation from the fibrous portion of the maxillary sinus periosteum separated the antrum from the oral cavity completely within 7-14 d following the experimental oro-paranasal communication. Oro-paranasal fistulas did not develop in any of the experimental animals.

A review of the common methods of closure of oroantral fistulas has been presented. On the basis of our clinical experience, we believe that the use of gold plate as a temporary obturator leading to complete closure provides the simplest, most comfortable, and most prosthetically effective technique for dealing with this problem. This operation can be particularly useful when an immediate denture is being constructed.

This report deals with a case of post traumatic leakage of cerebrospinal fluid through the ear which soon subsided, but recurred 5 months later, this time through the Eustachian tube and nose. The cau

The management of various types of oroantral perforation has been discussed in detail. Oroantral perforation often occurs in spite of adequate precautions in the surgical extraction of a tooth opening into the floor of the sinus. Failure to heal is generally due to infection or to a drain, plug, or gauze pack that has been inserted in the extraction wound after the perforation during removal of a root or during curettage. Plastic closure following such an accident may not be successful, either for technical reasons or because the sinus becomes infected. An alveolar opening often can be repaired by direct transposition of a fullthickness pedicle palatal flap. With this single-stage operation, a fistula may be adequately closed even though several attempts have been made with other techniques.

1. 1. A case is reported of a possible osteoma in the left maxillary sinus of a 61-year-old man. 2. 2. This was discovered on clinical and roentgenographic examination of the area. A past history of an oroantral fistula following a tooth extraction in this area was obtained. 3. 3. As no biopsy was taken the diagnosis of a definite type of tumor cannot be established.

Summary A dental cyst presenting as a facial sinus is recorded, the literature regarding facial sinuses reviewed and the treatment of this particular case is discussed.

One hundred and fourteen patients with oroantral communication were operated at the Department of Oral Surgery and Oral Medicine, Dental Faculty, University of Oslo, during the 4-year period 1968–1972. The closure method used was the buccal nonrotating flap technique as described by Moczar in 1930. Five cases (4.3 %) failed to heal primarily. Three of these healed spontaneously within 1 month postoperatively. Preoperative diagnostic procedures are described as well as the Moczar surgical approach and the follow-up regime. Vestibular height was found to have normalized in 88% of the patients examined. The gingival condition was examined before and after surgery in 61 patients. In all these cases, pocket depths were found to have been reestablished to preoperative values within 3 months postoperatively. Requirements of the optimal surgical procedure for closure of oroantral communication are stressed, and the most common errors causing failure or recurrence are listed.

IT IS THE intention of this article to discuss the problems in the treatment of oroantral fistulas and to re-present an operation for their closure that has not received the recognition it deserves. Alveolar fistulas may be divided into two types: the acute, or those of recent origin; and the chronic, or those of long duration. ACUTE OROANTRAL FISTULA Extraction of one of the upper molar teeth is the usual cause of acute oroantral fistulas. They are therefore first seen by the dentist, although the rhinologist may be consulted to help care for the sinus complication. Rhinologists are fairly well agreed regarding the management of the acute condition, as mentioned in Barton's1asummary. The fundamentals of treatment of acute oroantral fistulas include (1) adequate antimicrobial therapy, preferably penicillin; (2) no manipulation through the fistula (which includes no probing, no packing into the antrum, and no irrigation of the antrum