J Korean Assoc Oral Maxillofac Surg.  2020 Feb;46(1):58-65. 10.5125/jkaoms.2020.46.1.58.

Closure of oroantral fistula: a review of local flap techniques

• Kwon MS
• Lee BS
• Choi BJ
• Lee JW
• Ohe JY
• Jung JH
• Hwang BY
• Kwon YD

• KMID: 2471113
• DOI: http://doi.org/10.5125/jkaoms.2020.46.1.58

Abstract

Oroantral fistula (OAF), also termed oroantral communication, is an abnormal condition in which there is a communicating tract between the maxillary sinus and the oral cavity. The most common causes of this pathological communication are known to be dental implant surgery and extraction of posterior maxillary teeth. The purpose of this article is to describe OAF; introduce the approach algorithm for the treatment of OAF; and review the fundamental surgical techniques for fistula closure with their advantages and disadvantages. The author included a thorough review of the previous studies acquired from the PubMed database. Based on this review, this article presents cases of OAF patients treated with buccal flap, buccal fat pad (BFP), and palatal rotational flap techniques.

Keyword

Oroantral fistula; Buccal flap; Buccal fat pad; Palatal rotational flap

MeSH Terms

Adipose Tissue
Dental Implants
Fistula
Humans
Maxillary Sinus
Mouth
Oroantral Fistula*
Tooth
Dental Implants

Figure

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  Fig. 1 Treatment modalities for oroantral fistula (OAF) closure. Modified from the article of Parvini et al.3 (Int J Implant Dent 2018;4:40) in accordance with the Creative Commons Attribution 4.0 International (CC BY 4.0) license.

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  Fig. 2 A. Panorama shows a suspicious lesion at the extraction site of the posterior maxilla. B. Opacity of the right maxillary sinus is decreased on Waters' view due to the sinus infection.

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  Fig. 3 Cone-beam computed tomography imaging confirms the connected tract (A) and the sinus infection (B) on the right maxillary sinus.

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  Fig. 4 Approach algorithm for the treatment of oroantral fistula.

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  Fig. 5 A. shows a fistula the size of a single tooth on the second premolar region of the maxilla. B. The buccal sliding flap covering over the fistula and sutured with the palatal mucosa can be seen. C. Complete healing was obtained at three weeks after the surgery.

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  Fig. 6 A, B. Partial maxillectomy was performed to remove the necrotic region of the maxilla. C. Harvest of the abundant amount of the buccal fat pad (BFP). D. The defect was covered with the BFP and oral mucosa by double-layered suture. E. Complete healing was observed, and no signs of complications were noted at 11 weeks after the surgery.

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  Fig. 7 A, B. Circular excision of the fistula tract reveals a larger entrance than as suggested from the outside.

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  Fig. 8 A. Full-thickness palatal harvest includes the greater palatine artery. B. Subepithelial dissection of the rotating region of the flap. C. The flap was rotated and placed through the fistula tract underneath the tunnel. D. The flap was sutured to the remaining buccal mucosa and, also, the rotated area of the flap was sutured to limit undesired movement of the flap during the healing period. E. The collagen sponge was used to cover the denuded donor site. F. The secondary wound healing of the donor site can be seen. G. Complete healing without complications was observed at two months of follow-up.

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