Oroantral fistula and genian mucosal flap: a review of 25 cases

Oro-Antral Fistulas and their Management: Our Experience

Oroantral fistula (OAF) is an epithelized, pathological communication between the maxillary antrum and oral cavity. The most common etiological factor is molar or premolar tooth extraction. The bone between maxillary sinus floor and posterior teeth is thin and occasionally the root apices of the posterior teeth reach the maxillary sinus, predisposing them to the formation of OAF. Other causes are bacterial or fungal infections, osteomyelitis, granulomatous diseases, Paget's disease, malignancy, maxillofacial trauma and iatrogenic. Small OAFs heal spontaneously but larger fistulas, persisting more than three weeks need to be closed. In repairing the persistent OAF, the maxillary sinus must be addressed. Maxillary sinusitis may lead to the failure of closure of the OAF. The basic modus operandi is clearance of disease from the sinus and covering the defect with a suitable graft. Various local and distant flaps are used to repair the OAF. We report three cases of OAF, managed by three different techniques. We also suggest a combined approach for large OAFs, repaired in 3 layers using septal cartilage, fat, and a buccal muco-periosteal advancement flap.

Treatment of Oroantral Communication Using the Lateral Palatal Sliding Flap Technique

Herein, we present a case of oroantral communication that was to be treated with clinical examination, tomography, and prototyping. A patient presented with oroantral communication with purulent exudation for 4 months, since the displacement of the dental implant and O-ring component to the maxillary sinus. Tomographic examination and prototyping revealed a 5 mm bone gap. The patient underwent local washes and antibiotic therapy. After local palpation, a bone defect detected by prototyping was suspected to be greater than that observed. For the surgery, a communication tunnel was made, and the bone defect was found to be 12 mm in diameter. A pedicle flap was raised on the palate, followed by sliding and suturing. No complications were observed during the postoperative period, and the suture was removed after a week. Four months later, communication did not resume, and the patient did not complain of pain, foul smelling, or purulent discharge and was satisfied with the outcome. The findings of this case suggest that the lateral sliding flap can be used as an efficient technique for closing oroantral communications. An accurate clinical examination is a critical tool that can be used instead of tomography and prototyping, which can be misleading.