Secondary closure of oroantral and oronasal fistulas: a modification of existing techniques

Rose-trellis periosteal release in oral mucosal advancement flaps in pigs

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.

Comparison of the Clinical Outcomes of Buccal Advancement Flap Versus Platelet-Rich Fibrin Application for the Immediate Closure of Acute Oroantral Communications

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.

Iatrogenic transposition of the parotid duct into the maxillary sinus after tooth extraction and closure of an oroantral fistula. A case report

CASE REPORT

We report the clinical course of a patient with a rare iatrogenic surgical complication of transposition of the Parotid duct into the maxillary sinus after tooth extraction.

DISCUSSION

Oroantral fistula occurs most frequently following maxillary molar or premolar extraction. Closure of an oroantral fistula is frequently closed using the buccal mucoperiosteal flap first described by Rehrmann in 1936. Transposition of the Parotid duct is a rare surgical complication of this technique.

CONCLUSION

Differential diagnosis of nonspecific discharge from the nose should take this rare cause into account as it is a common symptom of this complication. A careful and full patient history and the correlation of nasal secretion with food intake can lead to the diagnosis.

[Post syphilitic oro-nasal communication]

INTRODUCTION

Oro-nasal communication occurs due to a lack of bone and mucous membranes between the oral cavity and the nasal fossae, rarely subsequent to tertiary syphilis.

CASE REPORT

A 27 year-old woman with a history of an untreated genital chancre which developed 7 years earlier, presented hard palate necrosis surrounded with granulation tissue. Syphilitic gum of the hard palate was diagnosed. After antibiotic treatment, the palatine lesion healed with persistence of an oro-nasal fistula. Physical examination of the oral cavity demonstrated median oro-nasal communication of the hard palate measuring 0,5 cm in diameter. HIV and syphilitic serologies were negative. The treatment consisted in surgical closure of the oro-nasal communication by the refection of nasal and oral plans. The follow-up was good.

DISCUSSION

Oro-nasal communication due to syphilis is exceptional, of easy diagnosis and generally needs surgical treatment.

Bony palatal necrosis in a diabetic patient secondary to palatal rotational flap

Donor site necrosis is a very rare complication of palatal rotational flaps. The aim of this case report is to present a 43-year-old female, Type I diabetic patient with a chronic oroantral fistula in the right second molar region. The patient had bony necrosis in the donor site following palatal rotational flap operation. The treatment approach and the alternative methods are discussed.

Bony press-fit closure of oro-antral fistulas: a technique for pre-sinus lift repair and secondary closure

PURPOSE

To evaluate the use of intra-oral bone grafts for closing chronic oro-antral fistulas (OAFs), for providing a sound basis for subsequent conventional sinus lifting and for preserving the teeth adjacent to OAFs.

PATIENTS AND METHODS

Twenty-one patients with oro-antral fistulas of variable origin were treated with monocortical bone blocks harvested from the retromolar or interforaminal regions of the mandible. The preoperative treatment, the surgical procedure for both hard and soft tissue closure, and the postoperative management are reviewed in detail.

RESULTS

Press-fit closure for repair of the bony sinus floor was sufficient in 17 patients. Four of them needed additional internal fixation. In all 21 patients adequate closure of the fistulas was obtained, although 3 patients (14.3%) developed wound dehiscences at the grafted sites, which healed by secondary intention. Meanwhile, 3 patients underwent successful sinus lifting.

CONCLUSION

The use of monocortical bone grafts harvested at intra-oral donor sites is a safe and easy technique for repairing defects of the maxilla, especially OAFs in need of secondary closure. It provides a sound basis for subsequent conventional sinus lifting and preserves the teeth adjacent to OAFs.

Palatal rotation-advancement flap for delayed repair of oroantral fistula: a retrospective evaluation of 63 cases

OBJECTIVE

To review our 17-year clinical experience with delayed oroantral fistula repair by palatal rotation-advancement flap, and to report its advantages, disadvantages, and complications.

STUDY DESIGN

The records of 63 patients with late oroantral fistula treated by palatal rotation-advancement flap from 1984 to 2002 were reviewed. Eleven had undergone unsuccessful closure with a buccal flap. Data recorded were patient age and sex, cause of fistula, signs and symptoms, interval from appearance of fistula to repair, fistula size, radiographic appearance, method of repair, and immediate and late complications.

RESULTS

There were 35 women and 28 men aged 21 to 71 years (mean 50.3 years). Surgery was performed 3 months to 20 years after injury (mean 1.8 years). Twenty-four patients had acute maxillary sinusitis and 39 had chronic sinusitis. The main causes of oroantral fistula were extraction of the second and first molars and pathological lesions within the sinus. Average fistula size was 2.3 cm x 1.6 cm. Fifty-one repairs were preceded by Caldwell-Luc operation. All fistulas were successfully closed with the palatal rotation-advancement flap, with minimal complications on long-term follow-up.

CONCLUSION

The palatal rotation-advancement flap is recommended for the late repair of oroantral fistula owing to its good vascularization, excellent thickness and tissue bulk, and easy accessibility; it also allows for the maintenance of the vestibular-sulcus depth. It is particularly indicated in cases of unsuccessful buccal flap closure.

Use of third molar transplantation for closure of the oroantral communication after tooth extraction: a report of 2 cases

OBJECTIVE

This clinical report introduces a promising and unique method for the immediate closure of the oroantral communication (OAC) after tooth extraction: the use of the transplanted third molar with closed apices.

STUDY DESIGN

In 2 adult patients, OAC caused by the extraction of an upper molar was immediately closed by using a transplanted third molar with complete root formation. After tooth extraction at the recipient site, OAC with perforated mucosa of the sinus floor was confirmed and the donor third molar was transferred to the prepared recipient socket. Endodontic therapy of the transplanted third molar began at 3 weeks after surgery, and prosthetic treatment was completed at 5 months after the operation. These 2 patients were carefully observed both clinically and radiographically.

RESULTS

Closure of the OAC was successfully performed, and the transplanted teeth became fixed with the passage of time in these 2 patients. Root resorption did not occur, and good functional results were obtained without any complications.

CONCLUSIONS

Tooth transplantation of a mature third molar for closure of the OAC is a simple and excellent method because the transplanted tooth not only closes the communication to the maxillary sinus, but it also satisfactorily functions at the recipient site during mastication, even in adult patients.

Application of the interseptal alveolotomy for closing the oroantral fistula

PURPOSE

This article describes a new application of the interseptal alveoplasty to close oroantral fistulae caused by dental extraction. The surgical technique is described, and its advantages are compared with those of other techniques.

MATERIALS AND METHODS

The technique was used to treat eight patients with comparatively small fistulae in the soft tissue, approximately 1 to 5 mm wide.

RESULTS

All fistulae were successfully closed.

CONCLUSION

It is proposed that the technique provides greater flexibility in the treatment of fistulae. In addition, because there is a bony base, this promotes more successful healing than other commonly used procedures.

Closure of oroantral communications using a pedicled buccal fat pad graft

PURPOSE

This report evaluates the use of a pedicled buccal fat pad graft for closure of oroantral fistulae.

MATERIALS AND METHODS

Fourteen patients with oroantral communications, ranging from 8 to 20 mm in diameter, were treated by the use of a pedicled buccal fat pad graft.

RESULTS

The procedure was successful in 13 of 14 patients. Postoperatively, the orally exposed fat gradually was transformed into a granulation-like tissue and epithelization developed within 3 weeks.

CONCLUSION

It was concluded that the procedure has wide application and a high degree of success.