Oro-antral fistulae--a study of clinical, radiological and treatment aspects

Clinical and radiological aspects of 86 patients with oro-antral fistulae were studied and two commonly employed methods of repair were compared. Fistulae were found to be twice as common in males as in females. The highest frequency was recorded in the fourth decade (41%), and the commonest site was the first molar region (49%). All patients had antral infection which is attributed to the long delay in the detection of fistulae. The most frequently observed radiological feature was polyps with mucosal thickening (49%). Comparison of results of surgical repair by a buccal flap method (Rehrmann, 1936) and a palatal flap method (Ashley, 1939) showed no significant difference (p greater than 0.05).

Short and long-term treatment results in chronic maxillary sinusitis

The diagnostic criteria and the length of the observation period are essential factors influencing the results of treatment of maxillary sinusitis. In 198 patients (244 sinuses) with chronic maxillary sinusitis of either rhinogenous or dental etiology all patients were judged as cured or improved at the short-term control 1-3 months after completion of therapy. The long-term observation (mean 3.5 years) revealed different figures of healing. Satisfactory results after conservative therapy were seen in only 34% while the Caldwell-Luc operation gave good results in 80%. In sinusitis of dental origin, dental treatment combined with local sinus surgery was successful in 90%. In 78 sinuses investigated by sinoscopy, discrepancy between the symptoms and the endoscopic findings was seen in 14 cases (18%). Information obtained by questionnaire is therefore unreliable. In 30 sinuses operated upon with the Caldwell-Luc procedure, discrepancy between radiographic and endoscopic findings was seen in 3 cases (10%). Contributory factors, e.g. nasal polyps, dental infections and nasal allergy were found in 48 out of 84 sinuses not completely healed at the long-term control. Patients treated for chronic maxillary sinusitis must be followed up over a long period. A clinical control after 1-2 years, including sinoscopy or sinus radiographs, is recommended even in patients free from symptoms of sinusitis. Sinoscopy seems to be more reliable than sinus radiography and should be performed if the sinus radiographs show any pathology. The patients are also recommended to visit their dentists regularly, due to the close relationship between dental infections and chronic maxillary sinus diseases.

The use of collagen in oral surgery

The suitability of collagen as a biomaterial for soft tissue temporary cover or implantation is discussed. Current methods used to cover areas denuded of mucosa in the mouth using split skin, mucosa and dermal autografts are examined. The properties of an ideal mucosal graft are stated and the suitability of a collagen heterograft in the form of freeze dried, chemically treated pigskin is questioned. A collagen xenograft has been used as a biological cover for areas of the mouth where soft tissue has been excised, for example, a denture irritation hyperplasia or leukaplakia and when increased wound strength or support is required to enable a wound to heal satisfactorily for example an oroantral communication. The results of the work are encouraging, demonstrating in most instances, satisfactory healing with no excess of granulation tissue, satisfactory mechanical properties in the early stages to resist the forces of mastication; a low rate of infection and no evidence of a hypersensitivity reaction to the modified foreign protein being evident clinically. Current adverse reactions seen after an injectable form of collagen is used are mentioned. A collagen xenograft would thus appear to satisfy many of the criteria of an 'ideal' biological cover and merits further critical examination.

The submucosal island flap in the closure of oro-antral fistula

A submucosal island palatal flap technique was used successfully in seven patients for closure of large oro-antral fistulae. The technique provides not only an island flap of submucosal connective tissue to close the fistula, but a flap of mucosa to cover the raw area of palatal bone. The advantages of the technique are that healing is satisfactory without denuded bone, the island flap has excellent mobility and does not produce bunching of the mucosa of the hard palate and recipient site, and dentures may be fitted early following the excellent healing of the wound.

A primate model for producing experimental alveolar cleft defects

A simplified surgical technique to create an alveolar cleft defect with oronasal communication was developed in 12 female rhesus monkeys. The defects fulfilled the following criteria: 1) a bilateral alveolar cleft with a minimal width of 1 cm; 2) presence of an oronasal communication lined by epithelium; 3) absence of any clinical signs of inflammation within the cleft defect area; and 4) presence of functional teeth on each side of the created defect.