Oroantral Openings and Their Surgical Correction

Abstract

If the maxillary sinus is opened in the course of the removal of a tooth or during some other oral operation, several clinical signs give immediate warning. The more common ones are escape of blood from the nostril, escape of air into the oral cavity during expiration, frothing of blood from the tooth socket and escape of liquids from the mouth through the nostril. These signs are often followed rapidly by local pain and inflammation within the sinus. Even suppuration and empyema may supervene within twenty-four to forty-eight hours. Furthermore, these local manifestations may be supplemented by more or less pronounced general symptoms of acute infection.In addition to the infection, the following important factors, besides others, help to determine the effect of the opening in individual cases: the cause of the opening; the conditions under which it occurred; its duration; the extent of immediate laceration of, and later changes in, the surrounding tissues; the location of the opening; the presence of adjoining teeth; the presence of pathologic conditions around the site of the removed tooth, and, finally, the condition of the sinus proper and of the associated anatomic structures.A considerable proportion of these openings close by granulation, as would an ordinary tooth socket. In a certain percentage, closure is delayed but still takes place without surgical intervention. In other cases, the opening remains patent and can be closed only by means of an operation. In any case natural closure should be encouraged and not retarded or prevented by unnecessary or injudicious packings of the tooth socket carried into the sinus. PRELIMINARY CONSIDERATIONSDental Relations and Local Pathologic Conditions.\p=m-\Itis well to have a clear understanding of the dental relations and the nature of the local pathologic conditions, since these induce characteristic morbid processes which should influence or determine the mode of treatment.From the

Use of Auricular Cartilage for Closure of Oroantral Fistula: A Prospective Clinical Study

“…A circular incision with a 2 mm margin was made around the oro-antral fistula, and the epithelial tract and any inflammatory tissue within the opening were completely excised (Fig. 3) and trapezoidal shape buccal sliding flap as described by Berger [13] was raised. After recipient site preparation, local anesthesia was infiltrated in post-auricular sulcus and conchal fossa for harvesting auricular cartilage graft (Fig.…”

Flap Techniques in Dentoalveolar Surgery

“…It has been described [14,29] the use of a buccal flap with a thin layer of buccinator muscle to close an oroantral defect. Later, [30] reported a buccal sliding flap technique, which is still in use, as a tool to close small to medium size (<1cm) lateral or mid-alveolar fistulas, located either laterally or in the middle of the alveolar process. Krompotie and Bagatin [13] reported the immediate closure of an oroantral communication by a rotating gingiva-vestibular flap.…”

Oroantral Fistula Management and Treatment

“…A lateral or midalveolar fistulas located either laterally or in the middle of the alveolar process which is of small to medium size less than 1cm can be closed using buccal sliding flap technique (6).A rotating gingivovestibular flap can also be used for the immediate closure of oroantral fistula (7,8) Two vertical incisions are made to provide a flap of suitable dimension after cutting the communication edges and an incision removal of the epithelium lining the palatal mucosa behind the communication is required. A trapezoidal flap consisting of both epithelium and connective tissue is positioned over the defect from the buccal flap to the palatal mucosa by mattress sutures (7) Advantages: This procedure can be done even when the alveolar ridge is resorbed extensively.…”