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Alrmali AE, Wang HL. Dental Pathophysiology of Odontogenic Sinusitis: Oral Surgical Complications. Otolaryngol Clin North Am 2024:S0030-6665(24)00103-8. [PMID: 39155170 DOI: 10.1016/j.otc.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
The article explores the understudied pathophysiology of odontogenic sinusitis (ODS) development as a result of oral surgical complications such as oroantral communication (OAC) or fistula (OAF), maxillary sinus bone grafting, and dental implantation. A temporary OAC presents most often after dental extraction, especially with posterior maxillary teeth, though can happen with any oral surgical intervention. Maxillary sinus augmentation can also cause ODS, and while the pathophysiology is incompletely understood, it may be related to OAC/OAF formation or bone graft infection. Dental implants may also lead to ODS either via displacement into the sinus, partial protrusion into the sinus, or peri-implantitis.
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Affiliation(s)
- Abdusalam E Alrmali
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA; Department of Oral Pathology, Oral Medicine and Oral and Maxillofacial Surgery, University of Tripoli, School of Dentistry, Tripoli, Libya
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA.
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Oliva S, Lorusso F, Scarano A, D’Amario M, Murmura G. The Treatment and Management of Oroantral Communications and Fistulas: A Systematic Review and Network Metanalysis. Dent J (Basel) 2024; 12:147. [PMID: 38786545 PMCID: PMC11120370 DOI: 10.3390/dj12050147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. MATERIALS AND METHODS An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: "oro antral communication (OAC)" OR "oro antral fistula (OAF)" OR "antro-oral communication" OR "communication between maxillary sinus and oral cavity" OR "oro-sinusal communication" OR "oro-sinusal fistula" OR "sinus communication" OR "sinus fistula" OR "antral communication" AND "treatment" OR "management" OR "surgical treatment" OR "surgical interventions". This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. RESULTS A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. CONCLUSIONS With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse.
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Affiliation(s)
- Stefano Oliva
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
| | - Maurizio D’Amario
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Giovanna Murmura
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (F.L.); (A.S.); (G.M.)
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Ibrahim MT, Gharieb EA, Sheta MS. A pedicled buccal periosteal flap for the closure of oro-antral fistula. BMC Oral Health 2024; 24:440. [PMID: 38600501 PMCID: PMC11007963 DOI: 10.1186/s12903-024-04217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND An oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis. PURPOSE This study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure. PATIENTS & METHODS Patients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined radiographically using computed tomography preoperatively. All patients underwent surgical closure of oroantral fistula using a pedicled buccal periosteal flap. RESULTS All 10 patients obtained satisfactory results with marked improvement in the function of the maxillary sinus and complete healing of oroantral fistula with no recurrence except in Case No. 5, who had a recurrence of the oroantral fistula, also there was no statistically significant difference between the vestibular depth preoperatively and postoperatively. CONCLUSION A pedicled buccal periosteal flap is a novel technique for oroantral fistula closure as it preserves vestibular depth with a tension-free closure flap and harbors the advantages of the regenerative potential of the periosteum. REGISTRATION DATE 14/8/2023 REGISTRATION NUMBER: NCT05987943.
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Affiliation(s)
- Marwa T Ibrahim
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, El-Giesh St, Tanta, Gharbia, Egypt.
| | - Eslam A Gharieb
- Department of Oral and Maxillofacial Surgery, Tanta University, El-Giesh, Tanta, Egypt
| | - Mona S Sheta
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University, El-Giesh St, Tanta, Gharbia, Egypt
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Helal MH, Ali AN, Ghoraba SF, Aboushelib MN. Prefabricated CAD-CAM scaffolds for management of oro-antral communication: A case report and histological analysis. Clin Implant Dent Relat Res 2024; 26:258-265. [PMID: 38225873 DOI: 10.1111/cid.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Oro-control communication is one of the complications associated with dental extraction and oral surgeries. This case report presents a minimally invasive surgical approach for bone regeneration at the site of oro-antral communication utilizing a prefabricated computer-aided design and computer-aided manufacturing (CAD-CAM) allogenic bone block. METHODS A 20-year-old healthy female, nonsmoker, with a badly destructed upper right first molar was referred for dental implant placement after extraction. Cone beam computerized tomography images revealed the presence of a large bone defect associated with oro-antral communication with the maxillary sinus and insufficient bone for dental implant placement. A prefabricated CAD-CAM allogenic bone scaffold was fabricated. After surgical exposure, the scaffold was secured in place and covered with a non-resorbable membrane. A dental implant was placed after 5 months, and a trephining biopsy was processed for histological evaluation. RESULTS Closure of the oro-antral communication was clinically observed. The average width of the alveolar bone was 12 mm, and the average height was 11 mm. Histological analysis at 5-month intervals showed thin newly formed bone trabeculae encircling remnants of graft material surrounded by osteoid tissue. The newly formed bone percentages were 32 ± 18% and 28 ± 17% volume remained after the biodegradation of the scaffold. Specific immune-histochemical staining by anti-vascular epithelial growth factor expression index value was 32.06%. CONCLUSIONS A prefabricated CAD-CAM scaffold was successfully used to seal a large oro-antral communication and regenerate sufficient bone to place a dental implant.
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Affiliation(s)
- Mohamed H Helal
- Oral Medicine, Periodontology, Oral Diagnosis, and Radiology Department, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Ahmed N Ali
- Department of Basic Medical and Dental Sciences, Faculty of Dentistry, Zarqa University, Zarqa, Jordan
- Oral Pathology Department, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Sahar F Ghoraba
- Oral Medicine, Periodontology, Oral Diagnosis, and Radiology Department, Faculty of Dentistry, Tanta University, Tanta, Egypt
| | - Moustafa N Aboushelib
- Dental Biomaterials Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Park WB, Bae MS, Park W, Lim HC, Han JY. A Novel Approach for the Treatment of Recurrent Oroantral Fistula Occurring at an Infected Sinus Augmentation Site. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:343. [PMID: 38399630 PMCID: PMC10890197 DOI: 10.3390/medicina60020343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Closing a recurrent oroantral fistula (OAF) that occurs at an infected sinus augmentation site is a challenge for clinicians. The recurrent OAF has a detrimental impact on bone regeneration and subsequent implant placement. This case report includes three cases in which sinus graft infection and OAF occurred after maxillary sinus augmentation (MSA). In these cases, treatments to control sinus infection were performed using an otolaryngologist; then, intraoral interventions comprising mucosal flap procedures, bone grafts, and barrier membrane applications were performed 2-5 times by oral surgeons. Nevertheless, OAF recurred persistently. The failure to stop OAF recurrence may be due to the inability to effectively block air pressure at the OAF site. Following a comprehensive debridement of the infected tissue at the previous sinus augmentation site, a pouch was created through sinus mucosal elevation. The perforated sinus mucosa at the OAF site was covered with a non-resorbable membrane in one case and with resorbable collagen membranes in the other two cases, followed by bone grafting within the pouch. Lastly, this procedure was completed by blocking the entrance of the pouch with a cortical bone shell graft and a resorbable collagen membrane. The cortical bone shell graft, obstructing the air pressure from the nasal cavity, facilitated bone formation, and, ultimately, allowed for implant placement. Within the limitations of the present case report, the application of a guided bone regeneration technique involving a cortical bone shell graft and a barrier membrane enabled the closure of the recurrent OAF and subsequent implant placement.
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea;
- Private Practice in Periodontics and Implant Dentistry, Seoul 02771, Republic of Korea
| | - Min-Soo Bae
- With Dental Clinic, #401 Dae-oh bldg, 53-1, Yeouinaru-ro, Yeongdeungpo-gu, Seoul 07273, Republic of Korea;
| | - Wonhee Park
- Department of Prosthodontics, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea;
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyunghee daero 23, Dongdaemoon-gu, Seoul 02447, Republic of Korea
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
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Wang A, Zhao C, Li Q, An Y, Xue J, Wang M. Repair of Oroantral Fistulas Using Free Bone and Mucoperiosteal Flaps After Endoscopic Removal of the Medial Wall of the Maxillary Sinus. J Craniofac Surg 2023:00001665-990000000-01236. [PMID: 37983370 DOI: 10.1097/scs.0000000000009911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Oroantral fistula (OAF) refers to a pathological connection between the oral cavity and maxillary sinus. It may lead to symptoms that include purulent mucus, nasal congestion, facial swelling, bad breath, and nasal regurgitation of food, all of which negatively impact patients' quality of life. OBJECTIVE This study presents a novel approach for OAF repair using a 2-layered structure composed of free bone and a mucoperiosteal flap obtained from the medial wall of maxillary sinus. MATERIALS AND METHODS Ten OAF patients who underwent repair using this method were retrospectively reviewed between August 2015 and June 2022. RESULTS The extraction of maxillary molars was the most common cause of OAF. The size of the fistulas ranged from 1×2 mm to 5×8 mm. Nine of the 10 patients achieved successful OAF closure following the initial operation using the 2-layer structure composed of free bone and mucoperiosteal flag. One patient was lost to follow-up. The 9 patients were observed for 6 months to 1 year, and they exhibited no obvious complications or recurrence. CONCLUSION The use of free bone and mucoperiosteal flag from the medial wall of maxillary sinus through an endoscope was effective for OAF repair.
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Affiliation(s)
- Ai Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan
| | - Changqing Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan
| | - Qingfeng Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan
| | - Yunfang An
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan
| | - Jinmei Xue
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan
| | - Min Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, People's Republic of China
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Hunger S, Krennmair S, Krennmair G, Otto S, Postl L, Nadalini DM. Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study. Clin Oral Investig 2023; 27:2713-2724. [PMID: 36607489 PMCID: PMC10264294 DOI: 10.1007/s00784-022-04846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level. MATERIAL AND METHODS Fifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry's wound healing index (score: 0-5), the displacement of the MGB, and the postoperative pain score were evaluated. RESULTS Five patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open-failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF. CONCLUSIONS Based on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border. CLINICAL RELEVANCE The defect size should be taken into account when choosing the number and size of PRF plugs.
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Affiliation(s)
- Stefan Hunger
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Clinic of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 7a, Linz, Austria
| | - Stefan Krennmair
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Gerald Krennmair
- Head of Department of Prosthodontics, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstr. 2a, 80337, Munich, Germany
| | - Lukas Postl
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - Danilo-Marc Nadalini
- Clinic of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstraße 7a, Linz, Austria
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Roghanizadeh L, Akbarzadeh Baghban A, Azizzadeh J, Asgary S. A Bibliometric Study on the Top 101 Most-Cited Articles of Dental Journals of the Middle East/North Africa Countries From 2011 to 2021. J Lasers Med Sci 2023; 14:e15. [PMID: 37583497 PMCID: PMC10423963 DOI: 10.34172/jlms.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 08/17/2023]
Abstract
Introduction: This retrospective descriptive study evaluated the Scopus-indexed dental journals and their most-cited documents affiliated with the Middle East and North Africa (MENA) countries from 2011 to 2021. Methods: Dental journals affiliated with MENA countries, their bibliometric indicators (SJR, CiteScore, SNIP, and H-index), and the 101 most cited articles of the considered journals were extracted and studied through descriptive statistics. In addition, the "citation per year" of each top 101 articles was calculated. Spearman's rho test was used for pairwise comparisons of the correlation coefficient values between each two of the considered bibliometric indicators. Results: The number of citations of the 101 most-cited papers ranged from 35 to 203. The mean (SD) citations of studied articles were 61.33 (37.58) and the median was 46. Furthermore, CiteScore had the highest significant correlation with SJR (r=0.828, P˂0.001). Moreover, the citation per year of the top 101 documents had no significant relationship with any of the journals' bibliometric indicators. Conclusion: Because journal performance and citation rate are multi-dimensional concepts, a single metric cannot express them thoroughly despite correlations between indices. "European Journal of Dentistry" from Turkey, "Saudi Dental Journal" from Saudi Arabia, and "Iranian Endodontic Journal" and "Journal of Lasers in Medical Sciences" both from Iran had the highest ranks in the SCImago portal and the highest scores in bibliometric indices amongst the MENA dental journals.
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Affiliation(s)
- Leyla Roghanizadeh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jila Azizzadeh
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sabatino L, Lopez MA, Di Giovanni S, Pierri M, Iafrati F, De Benedetto L, Moffa A, Casale M. Odontogenic Sinusitis with Oroantral Communication and Fistula Management: Role of Regenerative Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050937. [PMID: 37241169 DOI: 10.3390/medicina59050937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.
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Affiliation(s)
- Lorenzo Sabatino
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Michele Antonio Lopez
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Specialised Odontostomatology Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Simone Di Giovanni
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Michelangelo Pierri
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Francesco Iafrati
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Luigi De Benedetto
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Antonio Moffa
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Manuele Casale
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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Muacevic A, Adler JR, Sanjenbam N, Thounaojam N, Geeta R, Bagde H. A Double Barrier Technique in Surgical Closure of Oroantral Communication. Cureus 2022; 14:e31671. [PMID: 36545175 PMCID: PMC9762534 DOI: 10.7759/cureus.31671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/19/2022] [Indexed: 11/20/2022] Open
Abstract
Routine minor surgical procedures in the maxillary premolar or molar region often heal without any repercussions; however, some may culminate in an unintentional opening into the maxillary sinus, leading to the formation of oroantral communication. It is, therefore, imperative for a surgeon to recognize it and treat it sequentially to avoid long-term complications. This case report highlights a flapless double membrane closure of oroantral communication (OAC) with platelet-rich fibrin (PRF) and guided tissue regeneration (GTR) membranes and its edge over conventional methods.
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Verma RR, Verma R. Oro-Antral Fistulas and their Management: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:1576-1583. [PMID: 36452794 PMCID: PMC9702377 DOI: 10.1007/s12070-021-02739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ravinder Verma
- Verma Hospital and Research Centre, Gujral Nagar, Jalandhar, 144001 India
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Azzouzi A, Hallab L, Chbicheb S. Diagnosis and Management of oro-antral fistula: Case series and review. Int J Surg Case Rep 2022; 97:107436. [PMID: 35917603 PMCID: PMC9403197 DOI: 10.1016/j.ijscr.2022.107436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Asma Azzouzi
- Department Of Oral Surgery, C.C.D.T, Faculty Of Dentistry, University Mohammed V in Rabat, Morocco.
| | - Lamiae Hallab
- Department Of Oral Surgery, C.C.D.T, Faculty Of Dentistry, University Mohammed V in Rabat, Morocco
| | - Saliha Chbicheb
- Department Of Oral Surgery, C.C.D.T, Faculty Of Dentistry, University Mohammed V in Rabat, Morocco
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13
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Performance Analysis of Supervised Machine Learning Algorithms for Automatized Radiographical Classification of Maxillary Third Molar Impaction. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: Oro-antral communication (OAC) is a common complication following the extraction of upper molar teeth. The Archer and the Root Sinus (RS) systems can be used to classify impacted teeth in panoramic radiographs. The Archer classes B-D and the Root Sinus classes III, IV have been associated with an increased risk of OAC following tooth extraction in the upper molar region. In our previous study, we found that panoramic radiographs are not reliable for predicting OAC. This study aimed to (1) determine the feasibility of automating the classification (Archer/RS classes) of impacted teeth from panoramic radiographs, (2) determine the distribution of OAC stratified by classification system classes for the purposes of decision tree construction, and (3) determine the feasibility of automating the prediction of OAC utilizing the mentioned classification systems. Methods: We utilized multiple supervised pre-trained machine learning models (VGG16, ResNet50, Inceptionv3, EfficientNet, MobileNetV2), one custom-made convolutional neural network (CNN) model, and a Bag of Visual Words (BoVW) technique to evaluate the performance to predict the clinical classification systems RS and Archer from panoramic radiographs (Aim 1). We then used Chi-square Automatic Interaction Detectors (CHAID) to determine the distribution of OAC stratified by the Archer/RS classes to introduce a decision tree for simple use in clinics (Aim 2). Lastly, we tested the ability of a multilayer perceptron artificial neural network (MLP) and a radial basis function neural network (RBNN) to predict OAC based on the high-risk classes RS III, IV, and Archer B-D (Aim 3). Results: We achieved accuracies of up to 0.771 for EfficientNet and MobileNetV2 when examining the Archer classification. For the AUC, we obtained values of up to 0.902 for our custom-made CNN. In comparison, the detection of the RS classification achieved accuracies of up to 0.792 for the BoVW and an AUC of up to 0.716 for our custom-made CNN. Overall, the Archer classification was detected more reliably than the RS classification when considering all algorithms. CHAID predicted 77.4% correctness for the Archer classification and 81.4% for the RS classification. MLP (AUC: 0.590) and RBNN (AUC: 0.590) for the Archer classification as well as MLP 0.638) and RBNN (0.630) for the RS classification did not show sufficient predictive capability for OAC. Conclusions: The results reveal that impacted teeth can be classified using panoramic radiographs (best AUC: 0.902), and the classification systems can be stratified according to their relationship to OAC (81.4% correct for RS classification). However, the Archer and RS classes did not achieve satisfactory AUCs for predicting OAC (best AUC: 0.638). Additional research is needed to validate the results externally and to develop a reliable risk stratification tool based on the present findings.
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14
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Koppolu P, Khan TA, A Almarshad AA, Lingam AS, Afroz MM, Alanazi HF. Management of a 20-year-old longstanding oroantral fistula: A case report and review of literature. Niger J Clin Pract 2022; 25:731-736. [PMID: 35593621 DOI: 10.4103/njcp.njcp_1911_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A systematic treatment plan and an appropriate selection of surgical technique are the critical requirements for an effective closure of oroantral fistula (OAF). A 45-year-old female patient had sinus opening after she underwent a surgical tooth extraction 20 years back. On her frequent visits to the dentists some attempts were made for closure including surgical intervention, only for the lesion to return back. Computerized tomography (CT) scan was taken to rule out any bony extension of a lesion, the CT revealed a 1 × 1 cm radiolucency with a through - through communication from the alveolar bone to the right maxillary sinus because of the bony defect in the floor of maxillary sinus along with thickening of the maxillary sinus lining. The closure of the defect was done by a lateral pedicle flap raised from the right side was elevated and laterally slid to cover the defect without tension and was sutured with 4-0 resorbable interrupted suture while maintaining a bare surgical bed covered by the periosteum and a thin layer of connective tissue. This technique provides immediate repair of the defect to the patient, and also maintains comparatively normal anatomic architecture to the oral cavity. Eight months postoperative follow-up revealed a complete closure of OAF without any complications. The findings of this case suggest that lateral sliding pedicle flap can be a conservative approach in managing a long-standing OAF.
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Affiliation(s)
- P Koppolu
- Department of Preventive, Dental Sciences, Dar Al Uloom University, Riyadh, KSA
| | - T A Khan
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - A A A Almarshad
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - A S Lingam
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - M M Afroz
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - H F Alanazi
- Department of Dentistry, Dr. Sulaiman Al Habib Medical Group, Riyadh, KSA
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15
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Salgado-Peralvo AO, Mateos-Moreno MV, Uribarri A, Kewalramani N, Peña-Cardelles JF, Velasco-Ortega E. Treatment of oroantral communication with Platelet-Rich Fibrin: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e367-e375. [PMID: 35318134 DOI: 10.1016/j.jormas.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oroantral communication (OAC) is the opening between the maxillary sinus and the oral cavity, which constitutes a gate for the mucosal infection in the maxillary sinus. On the other hand, an OAF develops when the OAC does not close spontaneously, remains manifest and is epithelialized. Several methods have been proposed to solve these situations, however, they are associated with increased postoperative morbidity and/or higher associated costs and require some experience of the surgeon to perform them. To overcome these disadvantages, the use of Platelet-Rich Fibrin (PRF) is proposed. The present study aims to perform a systematic review of the literature, collecting cases in which PRF was used in the treatment of OACs/OAFs. MATERIALS AND METHODS An electronic search of the MEDLINE database (via PubMed) and Web of Science was performed using the following MeSH terms (Medical Subjects Headings): (oroantral communication OR oroantral fistula OR buccosinusal communication) AND (platelet-rich fibrin OR prf OR fibrin mesh). The criteria used were those described by the PRISMA® Statement. The search was not time-restricted and was updated to April 2021. RESULTS After searching, 11 articles were included that met the established criteria. In these, PRF was used alone or in combination with bi- or trilaminar techniques achieving complete resolution in 100% of cases (n = 116). CONCLUSIONS With the limitations of this study, it can be established that PRF can be used alone for the treatment of OACs/OAFs up to 5 mm and, in larger defects, it is advisable to combine it with bi- or trilaminar techniques. PRF is an effective therapeutic option, with minimal associated postoperative morbidity compared to other techniques and allows the position of the mucogingival junction to be preserved. Its combination with bone grafting improves the starting point before the replacement of the missing tooth with a dental implant.
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Affiliation(s)
| | - María-Victoria Mateos-Moreno
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid 28040, Spain
| | - Andrea Uribarri
- Department of Basic Health Sciences, Rey Juan Carlos University, Madrid 28922, Spain
| | - Naresh Kewalramani
- Department of Nursery and Stomatology, Rey Juan Carlos University, Madrid 28922, Spain
| | | | - Eugenio Velasco-Ortega
- Department of Stomatology, Faculty of Dentistry, University of Seville, Seville 41009, Spain
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16
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The Combination of a Buccal Trapezoidal Flap With a Palatal Connective Pedicle Flap for the Closure of Oro-Antral Fistulae. J Craniofac Surg 2022; 33:2235-2239. [PMID: 35275863 DOI: 10.1097/scs.0000000000008617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Various surgical techniques have been developed for the closure of oro-antral fistulae (OAF), all of them presenting some limitations. Nineteen consecutive patients with a clinical diagnosis of OAF were enrolled in the present case series study. The technique being tested included the reflection of a buccal trapezoid flap with the OAF at its center. The lesion was then fully exposed and debrided. A palatal pedicle connective graft was split from the overlying mucosa and it was rotated over the lesion and under the buccal flap, thereby double-sealing the fistula. The superficial layer of the palatal flap was left at its primary position and sutured, thus ensuring primary intention healing of the palate. The patients were followed for 30 days. No patient showed residual oro-antral communication by the end of the follow-up period. The pain level was highest at the end of the first follow-up week, with a median visual analog scale of 4, which decreased to 3 in the second week, and to 0 in the fourth week. The same trend could be observed for Discomfort. The combination of a buccal flap with a split palatal connective tissue flap is an effective surgical technique with good predictability and high patient satisfaction levels.
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17
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Bell G, Howard L, Lamont T. Clinical and radiographic assessment and restoration of maxillary sinus function in relation to oro-antral fistula closure: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:432-441. [PMID: 35490135 DOI: 10.1016/j.oooo.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to determine current practice in assessment of maxillary sinus health during oro-antral fistula closure. METHOD A systematic review using specific MeSH headings between 1990 and September 2021 on Medline, Ovid, and PubMed was performed. The inclusion criterion was closure of oro-antral fistula in adult patients. Exclusion criteria were oro-antral fistula arising in children; or from trauma, malignancy, or developmental abnormality; or any osteonecrotic lesion of bone. Risk of bias for individual papers was not assessed. Oxford Centre for Evidence Based Medicine levels of evidence were recorded. RESULTS 4309 papers were identified, and 119 were eligible for review. Nineteen were from otolaryngology (16%), 25 from combined ear, nose, and throat (ENT) and oral/oral and maxillofacial (OS/OMF) surgery (21%), and 75 from OS/OMF surgery (63%). Preoperative rhinoscopy and cross-sectional imaging were reported in 33 papers (28%), reflecting the role of ENT with or without OS/OMFS. Sixty-eight did not record any formal assessment of maxillary sinus health (57%), of which 60 were from OS/OMF surgery (50%). Use of computed tomography was reported in 58 papers (49%), and use of cone beam computed tomography was reported in 8 papers (7%) but did not correlate with assessment of sinus health. DISCUSSION Most surgery for oro-antral fistual closure was undertaken without objective assessment of maxillary sinus health, pre- or postoperatively. The involvement of ENT was associated with formal assessment of maxillary sinus health.
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Affiliation(s)
- Garmon Bell
- Associate Specialist, Oral & Maxillofacial Surgery, Dumfries & Galloway Royal Infirmary, Dumfries, Scotland.
| | - Laura Howard
- Senior House Officer, Dublin University Dental Hospital, Lincoln Place, Dublin, Ireland
| | - Thomas Lamont
- Senior Lecturer in Restorative Dentistry, Dundee Dental Hospital, Dundee, Scotland
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18
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Mainassara Chekaraou S, Benjelloun L, El Harti K. Management of oro-antral fistula: Two case reports and review. Ann Med Surg (Lond) 2021; 69:102817. [PMID: 34527240 PMCID: PMC8429925 DOI: 10.1016/j.amsu.2021.102817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Laila Benjelloun
- Oral Surgery Resident/faculty of Dental Medicine-Rabat/ Mohammed V University of Rabat, Morocco
| | - Karima El Harti
- Oral Surgery Resident/faculty of Dental Medicine-Rabat/ Mohammed V University of Rabat, Morocco
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19
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Implant Placement after Closure of Oroantral Communication by Sinus Bone Graft Using a Collagen Barrier Membrane in the Shape of a Pouch: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2021; 57:medicina57060626. [PMID: 34208644 PMCID: PMC8235364 DOI: 10.3390/medicina57060626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Oro-antral communication (OAC) acts as a pathway for bacteria between the maxillary sinus and oral cavity, and is a common complication after the removal of a dental implant or extraction of a tooth from the maxillary posterior area. In the case of an untreated OAC, oro-antral fistula develops and becomes epithelialized. We aimed to introduce a treatment for OAC closure via a sinus bone grafting procedure using bone tacks and a collagen membrane with an allograft. The procedure was performed by applying an absorbable membrane made in pouch form. This membrane acted as a barrier for closing the large sinus membrane perforation. Bone tacks were used to fix the membranes. Subsequently, the maxillary sinus was filled with the allograft, and the absorbable membrane was reapplied. Primary closure was achieved by performing a periosteum-releasing incision for a tension-free suture. After 6 months, sufficient bone dimensions were gained without any occurrence of maxillary sinusitis or recurrence of OAC. Additional bone grafts and implantation could be performed to rehabilitate the maxillary posterior area. We conclude that this technique might be a useful treatment for reconstructing the maxillary posterior area with simultaneous sinus bone graft and OAC closure.
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20
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Alves IDS, Vendramini DFV, Leite CDC, Gebrim EMMS, Passos UL. Dental findings on face and neck imaging. Radiol Bras 2021; 54:107-114. [PMID: 33854265 PMCID: PMC8029935 DOI: 10.1590/0100-3984.2019.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
When it is necessary to evaluate dental structures, the typical method is to obtain intraoral or panoramic X-rays at specialized dental clinics. However, in the daily practice of head and neck radiology, or even general radiology, it is common to encounter clinical situations or examination findings related to dental problems that should not be ignored. Because such problems can often be responsible for the clinical complaints of patients, this review aims to assist radiologists in identifying and describing common dental conditions on computed tomography of paranasal sinuses, face, and neck. It is important for radiologists to have knowledge of dental arch anatomy and its relationships with facial structures, as well as of major dental pathologies, including periapical sclerotic lesions, odontogenic cysts, fistulas, and abscesses, together with knowledge of incidental findings without clinical repercussions, which should be easily identified and stressed by the radiologist when necessary. The imaging methods most commonly used in evaluation of paranasal sinuses and face are computed tomography and magnetic resonance imaging. Those methods allow radiologists to recognize and become familiar with the main dental findings. The description of such findings by a radiologist can lead to a change in treatment strategy.
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Affiliation(s)
| | | | - Claudia da Costa Leite
- Departamento de Radiologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Eloisa Maria Mello Santiago Gebrim
- Hospital Sírio-Libanês, São Paulo, SP, Brazil.,Departamento de Radiologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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21
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Selvaraj DSS, Gaikwad P, Ebenezer J. Palatal flap in bilateral inferior partial maxillectomy. BMJ Case Rep 2021; 14:e239006. [PMID: 33727288 PMCID: PMC7970296 DOI: 10.1136/bcr-2020-239006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/04/2022] Open
Abstract
Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.
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Affiliation(s)
| | - Pranay Gaikwad
- Department of General Surgery Unit 1, Christian Medical College and Hospital Vellore Department of Physiology, Vellore, Tamil Nadu, India
| | - Jagadish Ebenezer
- Department of Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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22
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Abstract
Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.
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Affiliation(s)
- Natasha Bhalla
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
| | - Feiyi Sun
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
| | - Harry Dym
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA.
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Abstract
Odontogenic maxillary sinusitis (OMS) is a disease in which inflammation from the teeth extend into the maxillary sinus, causing symptoms of unilateral sinusitis. OMS can recur, with some being resistant to antibiotics. In intractable cases, exodontia and endoscopic sinus surgery (ESS) are necessary treatments. Here we report our analysis on the indications for surgical intervention in cases diagnosed with and treated as OMS. We retrospectively examined 186 patients who were diagnosed with sinusitis on a computed tomography (CT) scan. For cases diagnosed with OMS, the site of the causative tooth and the presence or absence of oroantral fistula to the maxillary sinus was examined. In addition, we analyzed the therapeutic efficacy of the initial treatment of antibiotics, and what the indications were for ESS. Among the patients examined, OMS was diagnosed in 44 cases (23.6%). In 14 out of 20 cases that underwent a post-medical treatment CT scan, OMS found to be treatment-resistant. Of these 14 cases, 12 (88%) had oroantral fistulae to the maxillary sinus. In all cases where exodontia, fistula closure surgery, and endoscopic sinus surgery (ESS) were performed, the fistula disappeared and the shadow of inflammation in the paranasal sinus improved. In OMS with oroantral fistula, ESS, exodontia, and fistula closure should be recommended over medication such as macrolide therapy.
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An Unusual Complication in Plastic Periodontal Surgery. Case Rep Dent 2020; 2020:8824246. [PMID: 33312741 PMCID: PMC7719491 DOI: 10.1155/2020/8824246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Oroantral communications may arise as a result of pathological processes or iatrogenic situations, particularly in oral surgery and implantology, but are uncommon in periodontal plastic surgery. Case Presentation. A healthy 37-year-old female patient with 5 mm Miller Class II recession on the maxillary left second molar was referred for a root coverage procedure. While preparing the recipient bed for the graft, an oroantral communication was created. Schneiderian membrane was sutured to reduce the dimension of the communication and covered with a connective tissue graft. Finally, the flap was laterally and coronally moved, and the patient instructed about postoperative precautions. This procedure allowed to achieve a complete closure of the oroantral communication and good root coverage after an 8-month follow-up. Conclusions Different authors described different techniques that can be used to close oroantral communications. Nevertheless, in this clinical case, it was shown that the oroantral communication may be closed without having to postpone the periodontal plastic surgery.
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Abstract
Platelet rich fibrin (PRF) is an autologous biological product which becomes popular day by day and available in a wide variety of fields in medicine. Platelet concentrates which are introduced at the early 90s have evolved over the years. The use such autologous materials have become trendy in recent years to encounter demanding expectations of patients, improve treatment success and maximize patient comfort. Despite its increasing use in dentistry and oral surgery, the most indications and effects are still being discussed. PRF is easily accepted by patients because of its low cost, easy to receive, low donor morbidity, low postoperative complication and infection rate. This biomaterial may be a solution for patients who have strong negative beliefs about the use of allografts and xenografts or who are afraid of complications during the grafting procedure. The objectives of these technologies are to use their synergistic effect to improve the hard and soft tissue regeneration. PRF in oral surgery are used for alveolar bone reconstruction, dental implant surgery, sinus augmentation, socket preservation, osteonecrosis, oroantral fistula closure, struggling with oral ulcers, preventing swelling and edema constitution. This chapter aims to review the clinical applications of platelets in oral surgery and the role of molecular components in tissue healing.
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Ben-Zvi Y, Rosenfeld E, Masri D, Avishai G, Chaushu G, Chaushu L. Clinical and radiological characteristics of oro-antral communications/fistulae due to implant dentistry procedures: A cross-sectional retrospective study. Clin Implant Dent Relat Res 2020; 23:54-60. [PMID: 33170558 DOI: 10.1111/cid.12962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Assess the unique clinical and radiological sequelae following oro-antral communications/fistulae (OAC/OAF) due to implant dentistry vs other etiologies. MATERIALS AND METHODS A structured form served to collect data from medical records. All consecutive patients who underwent surgical closure of OACs/OAFs between 2003 and 2020, at a single center were included. Demographic, radiological, clinical, operative and postoperative characteristics were collected. The differences between groups (cases with implant dentistry etiology [IDE] vs cases with other etiologies) were assessed statistically. RESULTS Data were gathered from 121 cases. The findings show that IDE cases were more likely to be of older age (OR = 1.07, CI [1.02, 1.13] P = .02); to have a foreign body in the maxillary sinus (OR = 21.04, CI [4.34, 114.92] P < .01); to have fluid passage (OR = 11.40, CI [1.87, 118.73] P = .02) and purulent discharge through the fistula (OR = 3.52, CI [0.86, 16.34] P = .09). CONCLUSIONS Clinical and radiological sequelae due to OACs/OAFs secondary to implant dentistry procedures are more severe compared to other etiologies. The suggested pathogenesis is foreign body reaction. Early and accurate diagnosis of the foreign body location, followed by its early removal is recommended.
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Affiliation(s)
- Yehonatan Ben-Zvi
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Eli Rosenfeld
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Daya Masri
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Gal Avishai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach-Tikva, Israel.,Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Chaushu
- Department of Periodontology and Oral Implantology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Psillas G, Papaioannou D, Petsali S, Dimas GG, Constantinidis J. Odontogenic maxillary sinusitis: A comprehensive review. J Dent Sci 2020; 16:474-481. [PMID: 33384837 PMCID: PMC7770314 DOI: 10.1016/j.jds.2020.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/08/2020] [Indexed: 02/07/2023] Open
Abstract
Odontogenic maxillary sinusitis (OMS) is a well-recognized condition in both the dental and otolaryngology communities. Close to 30% of cases of unilateral maxillary sinusitis may have an underlying dental pathology. Failure to identify a dental cause usually lead to cases recalcitrant sinusitis often associated with serious complications. The aim of this study is to describe the literature findings on odontogenic maxillary sinusitis that discuss anatomy, epidemiology, etiology, bacteriology, diagnosis and treatment. The present review is based on a current search using bibliographic database and academic search engine. All the articles on odontogenic maxillary sinusitis published after 2000 were included. This study seeks to provide clinicians with evidence that motivates a comprehensive approach to the evaluation and management of OMS. Controversies on diagnosis and management have been addressed and data from different treatment plans were collected by exploring relevant publications. The surgical treatment of OMS is based essentially on the dental surgery, combined with endoscopic sinus surgery, in order to completely remove the infection, restore the physiological drainage of the sinus and prevent recurrences of sinusitis. A multidisciplinary otolaryngology and dental team is mandatory to successfully manage the dental pathology and the complications resulting from the dental treatments.
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Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Despoina Papaioannou
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Spyridoula Petsali
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios George Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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28
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Sella A, Ben-Zvi Y, Gillman L, Avishai G, Chaushu G, Rosenfeld E. Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E310. [PMID: 32585934 PMCID: PMC7353848 DOI: 10.3390/medicina56060310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022]
Abstract
Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients' demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.
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Affiliation(s)
- Adi Sella
- Oral and Maxillofacial Surgery Unit, Shaare Zedek Medical Center, P.O.B 3235, 9103102 Jerusalem, Israel
| | - Yehonatan Ben-Zvi
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, 49100 Petach-Tikva, Israel; (Y.B.-Z.); (L.G.); (G.A.); (G.C.); (E.R.)
| | - Leon Gillman
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, 49100 Petach-Tikva, Israel; (Y.B.-Z.); (L.G.); (G.A.); (G.C.); (E.R.)
| | - Gal Avishai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, 49100 Petach-Tikva, Israel; (Y.B.-Z.); (L.G.); (G.A.); (G.C.); (E.R.)
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, 49100 Petach-Tikva, Israel; (Y.B.-Z.); (L.G.); (G.A.); (G.C.); (E.R.)
| | - Eli Rosenfeld
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, 49100 Petach-Tikva, Israel; (Y.B.-Z.); (L.G.); (G.A.); (G.C.); (E.R.)
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Saran S, Sharma Y, Khanna T, Singh AP. Maxillary mucormycosis causing oroantral fistula in a young female. Ann Afr Med 2020; 18:211-213. [PMID: 31823958 PMCID: PMC6918789 DOI: 10.4103/aam.aam_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sonal Saran
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Yash Sharma
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Tanvi Khanna
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Abhay Pratap Singh
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
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Blal K, Alterman M, Abu Tair J. A pedicled palatal periosteal flap for the closure of oro-antral fistula. Int J Oral Maxillofac Surg 2020; 49:1087-1091. [PMID: 32005570 DOI: 10.1016/j.ijom.2020.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 11/26/2019] [Accepted: 01/17/2020] [Indexed: 11/18/2022]
Abstract
Various surgical techniques have been developed for oro-antral fistula (OAF) closure, all of which have some drawback. Twenty consecutive patients with an OAF were enrolled in this prospective study. A trapezoid full-thickness flap extending from the palatal area to the buccal gingiva was raised, including the fistula at its centre. The palatal free end aspect was split into two layers and the deep periosteal layer was folded deep to the flap over the bony defect, thereby sealing the fistula. The superficial layer was returned to its primary position and sutured. The patients were followed for 3 months. Nineteen patients showed immediate OAF closure. One patient showed a residual oro-antral communication of 0.5mm in diameter that resolved spontaneously within 4 weeks. The pain level (on a visual analogue scale) was highest at the first follow-up week, with a mean score of 5.5, which decreased to a mean level of 2.5 in the second week and 0 in the fourth week. The mean satisfaction level was 9.85 on a scale of 0-10 (10 representing total satisfaction). The pedicled palatal periosteal flap is a simple and effective surgical technique with high predictability and patient satisfaction levels, offering one more alternative for the treatment of OAF.
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Affiliation(s)
- K Blal
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University - Hadassah, Jerusalem, Israel.
| | - M Alterman
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University - Hadassah, Jerusalem, Israel
| | - J Abu Tair
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University - Hadassah, Jerusalem, Israel; Arab American University, AAUP, Jenin, Palestinian Authority
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Vyloppilli S, Sayd S, Thangavelu A, Ranganathan M, Raseel S, Gopinath KA. Modified Palatal Flap with a Tissue Bridge in the Closure of the Oroantral Fistulae: A Prospective Study. J Maxillofac Oral Surg 2019; 18:604-609. [PMID: 31624444 DOI: 10.1007/s12663-018-1173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction An oroantral fistula is by definition 'An abnormal communication between the oral cavity and the maxillary sinus.' Aim of the study The aim of this study is to describe the acute and chronic OAFs and to evaluate the efficiency of the modified palatal flaps with tissue bridge in the closure of both acute and chronic OAFs of small to medium size. Methodology The study sample was derived from a population of patients from January 2013 to 2018 with the complaint of pain and discharge through the socket. Result The results of this series support the view that the use of modified palatal flap with tissue bridge is a reliable flap for the repair of both acute and chronic oroantral fistulae. Conclusion The ease of mobilization, superior blood supply and minimal donor site morbidity make it an ideal flap and a reliable alternative when other techniques fail.
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Affiliation(s)
- Suresh Vyloppilli
- 1Department of Oral and Maxillofacial Surgery, Malankara Orthodox Syrian Church Hospital and Medical College, Kolenchery, Ernakulam, India
| | - Shermil Sayd
- Department of Oral and Maxillofacial Surgery and Dentistry, Kannur Dental College and Hospitals, Anjarakandy, Kannur, India
| | - Annamalai Thangavelu
- Department of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospital, Chidambaram, Tamilnadu India
| | - Murugan Ranganathan
- Department of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospital, Chidambaram, Tamilnadu India
| | - Sarfras Raseel
- 4Department of Oral and Maxillofacial Surgery, KMCT Dental College and Hospitals, Mukkam, Calicut, India
| | - Kanur Arjun Gopinath
- Department of Oral and Maxillofacial Surgery and Dentistry, Kannur Dental College and Hospitals, Anjarakandy, Kannur, India
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Belmehdi A, El Harti K. Management of oroantral communication using buccal advanced flap. Pan Afr Med J 2019; 34:69. [PMID: 31819785 PMCID: PMC6884724 DOI: 10.11604/pamj.2019.34.69.19959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Abstract
Oroantral communication (OAC) or fistula (OAF) is an open pathological communication between the oral cavity and maxillary sinus which mostly occurs as a result of extraction of upper molars and premolars, iatrogenic complications or from dental infections, osteomyelitis, radiation therapy or trauma. Several alternative techniques modalities have been described throughout the years for the management of OAC and OAF which show both advantages and limitations. The most employed surgical flaps are of three types: advanced buccal flap, palatal flap and buccal fat pad flap. The authors present two clinical cases: oroantral communication and oroantral fistula, both were treated by using buccal advancement flap.
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Affiliation(s)
- Akram Belmehdi
- Oral surgeon, Dental Center of Treatment and Diagnosis Ibn Sina Hospital, Rabat, Morocco
| | - Karima El Harti
- Oral Surgery, Faculty of Dentistry of Rabat, Mohammed V University, Morocco
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33
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Three-Layered Closure of Persistent Oroantral Fistula Using Chin Graft, Buccal Fat Pad, and Buccal Advancement Flap: A Case Report with Review of Literature. Case Rep Dent 2019; 2019:8450749. [PMID: 31485358 PMCID: PMC6710802 DOI: 10.1155/2019/8450749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/20/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
Various techniques have been used for the repair of oroantral fistula (OAF) but majority of them have focused on the soft tissue closure alone, and most of the time, the osseous floor of the sinus was ignored. Existing literature supports that bone grafts supported by Buccal Fat Pad (BFP) heal well without undergoing significant resorption and necrosis. Through this case report, we wish to elaborate on the clinical success of using BFP and autogenous chin graft for simultaneous reconstruction of a large long-standing oroantral fistula with underlying osseous defect. The combination technique can prove beneficial for osseous regeneration of sinus floor and improve chances for future implant prosthetic rehabilitation.
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34
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Patel R, Patel P, Kalariya V, Patel H, Chavda C. Closure of Oro-Antral Communication Using Buccal Advancement Flap. World J Plast Surg 2019; 8:262-264. [PMID: 31309067 PMCID: PMC6620811 DOI: 10.29252/wjps.8.2.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Improper and inadequate treatment can lead to oro-antral communication and fistula. Certain surgical procedure during operation in posterior maxilla can lead to communication between oral cavity and sinus. In children and adolescents, the risk of oro-antral communication is less, due to smaller volume of the maxillary sinus defect smaller than 2 mm that would adequately heal without any intervention, but larger communications more than 2 mm would require immediate attention from surgeon and treatment should be done as soon possible in order to avoid further complications, infection and patient's discomfort.
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Affiliation(s)
- Ritul Patel
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Prutha Patel
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Viral Kalariya
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Het Patel
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
| | - Chetan Chavda
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada
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Alnofaie H, Alchawaf B, AlKindi M. Knowledge, awareness, and perception of oral and maxillofacial surgery among the public and professionals in Saudi Arabia: a cross-sectional study. Int J Oral Maxillofac Surg 2019; 48:1597-1603. [PMID: 31248704 DOI: 10.1016/j.ijom.2019.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 11/27/2022]
Abstract
Although oral and maxillofacial surgery (OMS) is expanding rapidly in Saudi Arabia, accurate knowledge of the specialty appears to be lacking. The aim of this study was to assess the knowledge, awareness, and perception of OMS among the public and professionals in Saudi Arabia. A cross-sectional design was adopted, incorporating five groups: dental interns, dental practitioners, medical interns, medical practitioners, and the public. A sample size of 130 was determined for each group, assuming a significance level of 5% and test power of 90%. Surveys were distributed randomly to participants from March to June 2018. For each of 15 specific clinical problems, respondents were asked to choose the most appropriate of three overlapping specialties for treatment, including OMS. A total of 1051 responses were collected. Participants correctly recognized OMS as appropriate for some problems, such as mandibular reconstruction, but for others recognition was poor. Surprisingly, medical professionals were the only group to strongly consider plastic surgery appropriate for treating orthognathic correction. Dental professionals were the most informed. This study highlights the need for greater awareness and education regarding OMS, promoting its development, contribution, and impact among the public and healthcare professionals in Saudi Arabia.
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Affiliation(s)
- H Alnofaie
- BDS, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; Teaching Assistant, Oral and Maxillofacial Surgery Division, Basic Dental Science Department, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - B Alchawaf
- Assistant Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - M AlKindi
- Associate Professor and Consultant, Head, Department of Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Ahn SK, Wee SY. Oroantral fistula after a zygomaticomaxillary complex fracture. Arch Craniofac Surg 2019; 20:212-216. [PMID: 31256562 PMCID: PMC6615425 DOI: 10.7181/acfs.2019.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/23/2019] [Indexed: 11/11/2022] Open
Abstract
Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a 2.0× 2.0 cm bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.
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Affiliation(s)
- Seung Ki Ahn
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Syeo Young Wee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
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37
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Durnovo EA, Fedorichev AO, Homutinnikova NE. [Modern view on the problem of oroantral fistula closure: literature review]. STOMATOLOGII︠A︡ 2019; 98:76-80. [PMID: 31089126 DOI: 10.17116/stomat20199802176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article includes a review of Russian and foreign literature concerning the current situation in problem of oroantral fistula closure. This review considers main concepts and methods of plastic surgery directed to reconstruct tightness of mouth. Moreover, the advantages and disadvantages of presented methods among themselves and appreciated long-term results and aftermath of different ways of surgical technics.
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Affiliation(s)
- E A Durnovo
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A O Fedorichev
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
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Li XY, Wu J, Cao J, Yang W, Wu B, Xie C. [Clinical analysis of acellular dermal matrix and acellular bone matrix in oro-antral fistula repair]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 36:633-637. [PMID: 30593109 DOI: 10.7518/hxkq.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the application of acellular dermal matrix and acellular bone matrix in the management of oro-antral fistula. METHODS Nine patients with oro-antral fistula (with defect greater than 5 mm×5 mm) after maxillary cyst resection or maxillary molar extraction were selected. The defects were repaired by the simultaneous implantation of acellular dermal matrix and acellular bone matrix. RESULTS The incisions of nine patients were all primary healing. After 6 months of follow-up, the oro-antral communication healed well, and no symptom such as nasal congestion or runny nose was observed. The clinical and CT examinations confirmed wound healing. CONCLUSIONS The usage of acellular dermal matrix and acellular bone matrix is a reliable repairing method for ora-antral fistula.
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Affiliation(s)
- Xiao-Yu Li
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Jing Wu
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Jun Cao
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Wei Yang
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Bin Wu
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Chun Xie
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
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Parvini P, Obreja K, Begic A, Schwarz F, Becker J, Sader R, Salti L. Decision-making in closure of oroantral communication and fistula. Int J Implant Dent 2019; 5:13. [PMID: 30931487 PMCID: PMC6441669 DOI: 10.1186/s40729-019-0165-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
After removal of a dental implant or extraction of a tooth in the upper jaw, the closure of an oroantral fistula (OAF) or oroantral communication (OAC) can be a difficult problem confronting the dentist and surgeon working in the oral and maxillofacial region. Oroantral communication (OAC) acts as a pathological pathway for bacteria and can cause infection of the antrum, which further obstructs the healing process as it is an unnatural communication between the oral cavity and the maxillary sinus. There are different ways to perform the surgical closure of the OAC. The decision-making in closure of oroantral communication and fistula is influenced by many factors. Consequently, it requires a combination of knowledge, experience, and information gathering. Previous narrative research has focused on assessments and comparisons of various surgical techniques for the closure of OAC/OAF. Thus, the decision-making process has not yet been described comprehensively. The present study aims to illustrate all the factors that have to be considered in the management of OACs and OAFs that determine optimal treatment.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany.
| | - Amira Begic
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany.,Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Loutfi Salti
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
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Parvini P, Obreja K, Sader R, Becker J, Schwarz F, Salti L. Surgical options in oroantral fistula management: a narrative review. Int J Implant Dent 2018; 4:40. [PMID: 30588578 PMCID: PMC6306369 DOI: 10.1186/s40729-018-0152-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022] Open
Abstract
An oroantral fistula (OAF) is a pathological abnormal communication between the oral cavity and the maxillary sinus which may arise as a result of failure of primary healing of an OAF, dental infections, osteomyelitis, radiation therapy, trauma, or iatrogenic complications. With the presence of a fistula, the maxillary sinus is permanently open. Microbial flora passes from the oral cavity into the maxillary sinus, and the inflammation of the sinus occurs with all potential consequences. In literature, various techniques have been proposed for closure of OAFs. Due to the heterogeneity of the data and techniques found, we opted for a narrative review to highlight the variety of techniques discussed in the literature. Techniques of particular interest include the bone sandwich with resorbable guided tissue regeneration (GTR) membrane and platelet-rich fibrin (PRF) used alone as both a clot and a membrane. The great advantage of these techniques is that no donor site surgery is necessary, making the outcome valuable in terms of time savings, cost and, more importantly, less discomfort to the patient. Additionally, both bony and soft tissue closure is performed for OAF, in contrast to flaps, which are typically used for procedures in the sinus area. The reconstructed bony tissue regenerated from these techniques will also be appropriate for endosseous dental implantation.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany.
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Loutfi Salti
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Comparison of the Clinical Outcomes of Buccal Advancement Flap Versus Platelet-Rich Fibrin Application for the Immediate Closure of Acute Oroantral Communications. J Craniofac Surg 2018; 30:e45-e49. [PMID: 30480627 DOI: 10.1097/scs.0000000000004958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Abstract
The aim of the present study was to investigate the role of Axiom (implant diameter) ø2.8 mm narrow body implant in the clinical effect of minimally invasive implants in edentulous space.This study included 10 patients with 10 edentulous spaces less than 5 mm and received minimally invasive surgery with 10 Axiom ø2.8 mm narrow implants. Re-stabilization of all implants began 6 months after surgery to fix the partial denture. All cases were followed up for clinical and panoramic X-ray examinations.Imaging examination on these 10 pieces of narrow implants after 6 months showed that implant alveolar bone crest average absorption amount was 0.20 mm and no implant peripheral inflammation mucositis and denture with adjacent teeth gingival papilla between the fillings. All patients felt strong mastication and the reparation effect was more than up to expectation. No implant loosening and shedding were observed.Hence, <5 mm edentulous space by Axiom ø2.8 mm implant minimally invasive reparation can be used for aesthetic purposes.
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Kiran Kumar Krishanappa S, Eachempati P, Kumbargere Nagraj S, Shetty NY, Moe S, Aggarwal H, Mathew RJ. Interventions for treating oro-antral communications and fistulae due to dental procedures. Cochrane Database Syst Rev 2018; 8:CD011784. [PMID: 30113083 PMCID: PMC6513579 DOI: 10.1002/14651858.cd011784.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND An oro-antral communication is an unnatural opening between the oral cavity and maxillary sinus. When it fails to close spontaneously, it remains patent and is epithelialized to develop into an oro-antral fistula. Various surgical and non-surgical techniques have been used for treating the condition. Surgical procedures include flaps, grafts and other techniques like re-implantation of third molars. Non-surgical techniques include allogenic materials and xenografts. This is an update of a review first published in May 2016. OBJECTIVES To assess the effectiveness and safety of various interventions for the treatment of oro-antral communications and fistulae due to dental procedures. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 23 May 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 4), MEDLINE Ovid (1946 to 23 May 2018), and Embase Ovid (1980 to 23 May 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We also searched the reference lists of included and excluded trials for any randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs evaluating any intervention for treating oro-antral communications or oro-antral fistulae due to dental procedures. We excluded quasi-RCTs and cross-over trials. We excluded studies on participants who had oro-antral communications, fistulae or both related to Caldwell-Luc procedure or surgical excision of tumours. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. Two review authors assessed trial risk of bias and extracted data independently. We estimated risk ratios (RR) for dichotomous data, with 95% confidence intervals (CI). We assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS We included only one study in this review, which compared two surgical interventions: pedicled buccal fat pad flap and buccal flap for the treatment of oro-antral communications. The study involved 20 participants. The risk of bias was unclear. The relevant outcome reported in this trial was successful (complete) closure of oro-antral communication.The quality of the evidence for the primary outcome was very low. The study did not find evidence of a difference between interventions for the successful (complete) closure of an oro-antral communication (RR 1.00, 95% Cl 0.83 to 1.20) one month after the surgery. All oro-antral communications in both groups were successfully closed so there were no adverse effects due to treatment failure.We did not find trials evaluating any other intervention for treating oro-antral communications or fistulae due to dental procedures. AUTHORS' CONCLUSIONS We found very low quality evidence from a single small study that compared pedicled buccal fat pad and buccal flap. The evidence was insufficient to judge whether there is a difference in the effectiveness of these interventions as all oro-antral communications in the study were successfully closed by one month after surgery. Large, well-conducted RCTs investigating different interventions for the treatment of oro-antral communications and fistulae caused by dental procedures are needed to inform clinical practice.
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Affiliation(s)
- Salian Kiran Kumar Krishanappa
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of ProsthodonticsJalan Batu HamparMelakaMalaysia75150
| | - Prashanti Eachempati
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of ProsthodonticsJalan Batu HamparMelakaMalaysia75150
| | - Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Oral Medicine and Oral RadiologyJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Naresh Yedthare Shetty
- International Medical University ‐ IMUSchool of Dentistry Oral & Maxillofacial SurgeryJalan Jalil Perkasa 19. No‐126Bukit JalilKuala LumpurMalaysia57000
| | - Soe Moe
- Melaka Manipal Medical CollegeCommunity MedicineMelakaMelakaMalaysia75150
| | - Himanshi Aggarwal
- Saraswati Dental College and HospitalDepartment of ProsthodonticsTiwariganj, Faizabad RoadLucknowUttar PradeshIndia227105
| | - Rebecca J Mathew
- Christian Medical CollegeSouth Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block, College Campus, BagayamVelloreTamil NaduIndia632002
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Renton T, Durham J, Hill CM. Oral surgery II: Part 2. The maxillary sinus (antrum) and oral surgery. Br Dent J 2018; 223:483-493. [PMID: 29026224 DOI: 10.1038/sj.bdj.2017.858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/09/2022]
Abstract
The maxillary sinus is the largest of the four paranasal sinuses and, being anatomically adjacent to the dentate region of the maxilla, is commonly a source of problems - not simply in terms of conditions affecting the sinus but also in establishing an accurate diagnosis. As anyone who has suffered both sinusitis and a dental abscess in the posterior maxilla will tell you, the symptoms are almost indistinguishable. For this reason, a sound understanding of the maxillary sinus is an essential requisite for all dentists.
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Affiliation(s)
| | - J Durham
- Newcastle Dental School, Newcastle University
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Niknami M, Mirmohammadi M, Pezeshki A. Evaluation of the Prevalence of Mucous Retention Pseudocyst and its Correlation with the Associated Risk Factors Using Panoramic Radiography and Cone-Beam Computed Tomography. JOURNAL OF DENTISTRY (TEHRAN, IRAN) 2018; 15:123-129. [PMID: 29971130 PMCID: PMC6026307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mucous retention pseudocyst (MRP) of the maxillary sinus is an incidental finding on radiographs. The radiographs taken for dental purposes provide an opportunity for dentists to recognize asymptomatic maxillary sinus anomalies. The purpose of this study was to determine the prevalence of MRP on panoramic and cone-beam computed tomography (CBCT) views and to evaluate the associated risk factors. MATERIALS AND METHODS In this study, 710 panoramic radiographs and 90 CBCT scans were examined with regard to the presence of MRP in the maxillary sinus during 2014-15. The MRP prevalence and some associated risk factors such as age, gender, season, smoking, allergy, asthma, chronic sinusitis, nasal polyp, mucosal thickening, and post-nasal drip (PND) were evaluated. RESULTS The frequency of MRP was 2.4% on the 710 evaluated panoramic images and 43.3% on the 90 evaluated CBCT views. The frequency of MRP on the panoramic and CBCT views was higher in males than in females. There was a significant association between smoking and MRP on panoramic images (P=0.02) and CBCT views (P<0.001). There was a significant association between PND and MRP on CBCT views (P=0.02). The highest frequency of MRP was seen in spring (P=0.04) according to panoramic radiographs and in spring and summer (P=0.001) according to CBCT views. CONCLUSIONS The occurrence of MRP had a significant association with smoking and PND, and the highest frequency of MRP was detected in spring and summer. Also, CBCT scanning detects MRP more accurately than panoramic radiography.
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Affiliation(s)
- Mahdi Niknami
- Assistant Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: M. Niknami, Department of Oral and Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran,
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Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment. Curr Opin Otolaryngol Head Neck Surg 2018; 26:27-33. [DOI: 10.1097/moo.0000000000000430] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim NG, Kim JO, Park YJ, Kim JS, Lee YJ, Lee KS. Cutaneous Basal Cell Carcinoma Arising in Odontogenic Cutaneous Fistula. Arch Craniofac Surg 2017; 18:141-144. [PMID: 28913323 PMCID: PMC5556897 DOI: 10.7181/acfs.2017.18.2.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022] Open
Abstract
An odontogenic cutaneous fistula is a pathological communication between the outer skin surface of the face and the oral cavity. Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with skin infection. We report a rare case, which was diagnosed as basal cell carcinoma based on the biopsy of skin lesions in the patient who had been diagnosed with odontogenic cutaneous fistula. A 64-year-old male patient presented with a cutaneous odontogenic fistula. The patient had undergone surgical extraction of fistula tract and loose tooth before dermatology or plastic surgery consultation. With the biopsy and computed tomography, it was confirmed that fistula and basal cell carcinoma. However, the connection between the fistula and skin cancer was not clear. Positron emission tomography-computed tomography scan was performed and was not detected as other local or distant metastasis. After that, wide excision of the skin lesion was performed. Although skin cancer is not commonly observed, it is necessary to rule out this disease entity by performing biopsy of skin lesions.
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Affiliation(s)
- Nam Gyun Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University, Jinju, Korea
| | - Jun Oh Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University, Jinju, Korea
| | - Young Ji Park
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University, Jinju, Korea
| | - Jun Sik Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University, Jinju, Korea
| | - Yoon Jung Lee
- Department of Plastic and Reconstructive Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Suk Lee
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, College of Medicine and Hospital, Gyeongsang National University, Jinju, Korea
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Khandelwal P, Hajira N. Management of Oro-antral Communication and Fistula: Various Surgical Options. World J Plast Surg 2017; 6:3-8. [PMID: 28289607 PMCID: PMC5339603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Oro-antral communication and fistula can occur as a result of inadequate and improper treatment. Inadvertent communication with the maxillary sinus can occur during certain surgical procedures in the maxillary posterior region. Though, spontaneous healing may occur in defects which are smaller than 2 mm but larger communications require immediate attention and should be treated without delay, in order to avoid sinusitis and further complications leading to patient discomfort.
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Affiliation(s)
- Pulkit Khandelwal
- Department of Oral and Maxillofacial Surgery, Vidhyadhar Nagar, Jaipur, Rajasthan, India;,Corresponding Author: Pulkit Khandelwal, MD, Department of Oral and Maxillofacial Surgery, Vidhyadhar Nagar, Jaipur, Rajasthan, India ,E-mail:
| | - Neha Hajira
- Department of Prosthodontics, Khushi Dental Care and Implant Centre, Bangalore, India
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Use of Auricular Cartilage for Closure of Oroantral Fistula: A Prospective Clinical Study. J Maxillofac Oral Surg 2016; 15:293-299. [PMID: 27752197 DOI: 10.1007/s12663-015-0841-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/28/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The term oro-antral fistula is understood to mean of fistular canal covered with epithelia which may or may not be filled with granulation tissue or polyposis of the sinus mucous membrane. With the presence of a fistula the sinus is permanently open, which enables the passage of microbial flora of the oral cavity into the maxillary sinus and the occurrence of inflammation with all possible consequences. Every now and then various researchers have proposed innumerable techniques to treat this defect. Starting from simple tissue flaps to autogenous grafts to alloplastic materials, an array of procedures have been evaluated in literature but the most promising technique still needs to be evaluated. Consequently, after reviewing an array of such procedures, our present study focussed on a new technique for the closer of oro-antral fistulas using autogenous auricular cartilage graft supported by buccal advancement flap. MATERIAL AND METHOD A total of 20 patients of oro-antral fistula were included in the study and after excising the fistular tract a double layer closure was done by placing auricular cartilage over the defect followed by buccal mucoperiosteal flap. The graft was harvested using posterior auricular approach. Assessment of patients was done at the end of 1 week, 3 weeks, 6 weeks, and 3 months. CONCLUSION We found that the autogenous auricular cartilage graft is an effective sealing material in oro-antral fistula closure. We recommend this technique for the defect size ≤10 mm2 in which future dental implant placement is sought as it allows easy sinus lifting procedure.
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Long-Term Effectiveness of the Pedicled Buccal Fat Pad in the Closure of a Large Oroantral Fistula. J Oral Maxillofac Surg 2016; 74:1718-22. [DOI: 10.1016/j.joms.2016.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/04/2016] [Accepted: 04/18/2016] [Indexed: 11/20/2022]
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