Introduction: The management of the oroantral fistula is mainly focused on th closure of the mucosa. The surgical management restoring the underlying bone defect are seldom. Maintaining this defect may compromise implant rehabilitation in this sector. The purpose of this article was to show, through a clinical case, an alternative way to manage an oroantral fistula and the bone tissue defect in the same time. Observation: After a rigourous clinical and radiological observation of a 2-year oroantral fistula, an impacted autologous bone graft of the maxillary tuberosity followed by a water tight closure of the mucosa, were realized in a 50-year old patient. Commentary: Using this surgical technique was successful for the closure of the mucosa as for the bone defect reconstruction. A consolidation was noticed and an pre-implant management and a dental implant placement could be realized. Conclusion: The choice of this surgical technique for the management of an oroantral fistua had a direct influence on the future prosthetic rehabilitation. The surgical technique presented for this case could be an interesting approach because the fixed or removable prosthetic treatment will be more effective if the maxillary bone tissue is reconstructed.
Introduction: Chronic maxillary atelectasis refers to a persistent volume decrease of the maxillary sinus by inward bowing of its walls. When associated with hypoglobus or enophthalmos, some authors use the term “silent sinus syndrome”. We aimed to report a case of accidental diagnosis of chronic maxillary atelectasis while investigating and treating a recurrent oroantral fistula. Observation: CT imaging showed a large bone defect and stage II chronic maxillary atelectasis. Closure of the oroantral fistula was performed with a combined surgical approach: functional endoscopic surgery and buccal fat pad flap. The follow up at 2 months showed no signs of recurrent oroantral fistula. Commentaries: Chronic maxillary atelectasis is separated into three stages, membranous deformity (stage I), bony deformity (stage II), and clinical deformity (stage III). The term silent sinus syndrome should be abandoned for stage III chronic maxillary atelectasis to allow for better collaboration between medical practitioners. Recurrent oroantral fistulas should be treated with a combined approach including endoscopic antrostomy and local flap. Conclusion: The association of functional endoscopic surgery and buccal fat pad flap were the key to success in this case allowing for oroantral fistula closure and treatment of chronic maxillary atelectasis.
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