Low quality evidence for treatment approaches for oro-antral communications

Selecting the Best Surgical Treatment Methods in Oro-Antral Communications

INTRODUCTION

an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large defects and underlying general conditions. Bichat fad pad flap is a multipotent pedicled fatty tissue that is easily accessible from the oral cavity that can be used for the closure of medium-sized defects, even in immunocompromised patients due to its stem cell capacity.

MATERIALS AND METHODS

the medical information of the patients diagnosed with oro-antral communications who were admitted and treated in the Oral and Maxillo-Facial Clinic Targu Mures, between 2013 and 2020 were analyzed. A database containing general information, reported causes, associated diseases, surgical methods used during admission, and relapses, was created. The information was statistically processed. The written consent and ethical approval were obtained.

RESULTS

the study shows that from a total of 140 cases, 72 were treated using buccal advancement flap, 49 using Bichat fat pad flap, and 19 using palatal flaps. The dimensions of the communications ranged between 0.3 cm and 1.5 cm. Several statistically significant results could be found when comparing the surgical methods. Of the 72 patients treated with buccal advancement flaps, 25 presented relapses as opposed to the patients treated with Bichat fat pad flaps who showed no complications, p < 0.05. Analysing this aspect further, all large defects (10 cases) ranging from 0.6 cm to 1.5 cm treated with advancement buccal flaps (Rehrmann flaps) showed relapses (p < 0.05). Considering the general conditions, out of 7 patients who received radiotherapy 4 presented relapses, as opposed to the healthy patients, p < 0.05. Regarding the reintervention for the relapsed cases, the majority of the cases treated a second time with buccal advancement flap (5 out of 7 cases) failed as opposed to the Bichat fat pad flap with no further relapses (p < 0.05).

CONCLUSIONS

the most frequently used surgical treatment is the buccal flap, which also has the highest relapse rate. Both primary treatment with Bichat fat-pad flap and re-treatment of relapses using this flap have had 100% success rates, even in patients with general associated conditions, in contrast with patients treated by using the buccal flap. The dimensions of the oro-antral communication and general conditions are crucial factors for the success of the surgical treatment.

Diagnosis and Management of oro-antral fistula: Case series and review

INTRODUCTION AND IMPORTANCE

The oro-antral communication (OAC) is a pathological opening between the maxillary sinus and the oral cavity. When it does not close spontaneously or if it is not treated, it remains permeable and epithelializes to develop into an oro-antral fistula (OAF) and can cause maxillary sinusitis.

CASES PRESENTATION

The authors present through 5 clinical cases the different steps of the surgical protocols opting for the buccal fat pad flap and the advanced buccal flap to treat OAF/OAC.

CLINICAL DISCUSSION

Surgical closure of the OAC within 48 h is recommended to avoid complications. Several alternative techniques have been described over the years for the management of the OAC and OAF, with their advantages and limitations. The most commonly used surgical flaps are of two types: the advanced buccal flap and the buccal fat pad (BFP) flap.

CONCLUSION

The adequate availability of the advanced buccal flap and the buccal fat pad (BFP) flap in the majority of patients, the easy handling, the minimal donor site morbidity as well as the excellent blood supply make them perfect flaps for the closure of OAF/OAC. However, follow-up remains a key point and very important to avoid complications. The present case series was limited by the small number of patients and the authors recommend a study with larger groups.

Management of oro-antral fistula: Two case reports and review

Oro-antral Communication is an unnatural communication between the oral cavity and maxillary sinus and when it fails to close spontaneously, it remains patent and is epithelialized so that oro-antral fistula develops. It is a common occurrence following removal of maxillary premolars and molars because of anatomic proximity of root apices of these teeth and maxillary antrum. Signs and symptoms of oro-antral fistula varies from free escape of fluids, pain, pus leakage, voice alteration, to pan-sinusitis. Several surgical options exist for its management, in particular the buccal fat pad technique, which has proved to be an effective and a reliable technique. We report in this article two-succefull cases of oro-antral fistula managed with buccal fat pad.