We Performed The Oroantral Fistula Closure With Buccal Fat Pad Flap

Oroantral Fistula (OAF) and Chronic Maxillary Sinusitis

About 6 months ago, the patient who underwent right molar tooth extraction and after which complaints of facial fullness, pain, feeling of food in the mouth getting into the nose, and pain hitting the teeth arose, was diagnosed with oroantral fistula and related maxillary sinusitis in a different dental clinic. He performed oroantral fistula repair with local mucosal flap techniques in the same clinic. The patient applied to our clinic because his complaints continued.

Chronic Maxillary Sinusitis,Oroantral fistula, OAF,Dental Sinusitis, Odontogenic Sinusitis,

Chronic Maxillary Sinusitis,Oroantral fistula, OAF,Dental Sinusitis, Odontogenic Sinusitis,

Chronic Maxillary Sinusitis,Oroantral fistula, OAF,Dental Sinusitis, Odontogenic Sinusitis,

Chronic Maxillary Sinusitis,Oroantral fistula, OAF,Dental Sinusitis, Odontogenic Sinusitis,

Chronic Maxillary Sinusitis,Oroantral fistula, OAF,Dental Sinusitis, Odontogenic Sinusitis,

On the paranasal sinus tomography of the patient above, a bone defect at the base of the right maxillary sinus was observed in the molar tooth area. It was observed that the maxillary sinus cavity was completely filled with inflammatory tissue. A diagnosis of "Odontogenic Sinusitis" or "Dental Sinusitis" was made. 

Oroantral Fistula Definition

Here, the abnormal transition or pathological connection between the oral cavity and the maxillary cavity, which occurs due to the bone defect in the floor of the maxillary sinus, is called "Oroantral Fistula". 

Cause of Oroantral Fistula 

During tooth extraction, especially in patients whose roots are very close to the maxillary interior, if oroantral fistula is detected immediately after tooth extraction, it can usually be closed with simple interventions. 

Precautions That Patients Should Take Care of As Soon as Oroantral Fistula Occurs

When the oroantral fistula is small, patients should be told that "vacuuming", blowing, or "pressurized inflation", "suction action" are inconvenient, while it is sufficient to follow them; in large fistulas and fistulas that do not close spontaneously, the oroantral fistula closure should be performed without delay.

It is convenient to sneeze without covering the mouth and nose. If pressurized sneezing is performed by closing the mouth and nose, the fistula may reopen and the spontaneous healing tissue may rupture.

Oroantral Fistula Symptoms and Treatment

The most common complaint emphasized in the early period in patients with oro-antral fistula is the escape of the food consumed by the patient during eating into the nasal cavity. Therefore, it should be closed without wasting time. In the late period, maxillary sinusitis and inflammation in the adjacent sinuses begin; if no treatment is done, chronic maxillary sinusitis may occur and epithelialization and granulation tissues appear in the fistula tract. The defect area must be closed using a membrane.

In the chronic period, symptoms of sinusitis, facial pain, toothache, inflammatory nasal discharge, a feeling of fullness on the face, and headache may be added in patients. In some patients, sinusitis symptoms do not regress despite long-term antibiotic therapy. This is because food residues and microbial contents regularly escape from the mouth into the sinus cavity.

The same problem has happened to me. After having my right premolar tooth extracted 9 years ago, I felt air and food rushing from my mouth to my nose. He noticed that the fistula closed spontaneously when I did not do pressure vacuuming, blowing and blowing movements for only a few days. You don't always get lucky this way. Since the fistula opened after tooth extraction is large, the probability of spontaneous fistula closure may be low, especially in patients whose tooth roots penetrate deeply into the sinus.

How Is Oroantral Fistula Repair Done?

If the oroantral fistula that occurs during tooth extraction is a few mm and the patient does not have maxillary sinusitis, the above-mentioned recommendations can be recommended to the patient, and it can be expected that the patient should pay attention to the pressure change, the patient's follow-up, and the fistula tract will heal and close by itself. However, if the defect at the floor of the maxillary sinus is large and there is a large opening, surgical procedure is required. Different techniques can be used for surgical closure of oroantral fistula. Of course, if the defect is large as soon as the fistula occurs, performing the procedure as soon as possible may increase the success rate.

Surgical techniques that can be applied for closure of oroantral fistulas

Surgical techniques and applications that can be used in oroantral fistula repair:

- closure with local flap techniques
It can be easily used in acute fistula repair.
- use of distant flaps
- use of adjacent cheek fat pad (Buccal fat pad flap (BFP) - Bichat fat pad)
- repair of fistula using tissues such as cartilage, bone, bone powder, muscle membrane, cartilage membrane
Local flap techniques can be used to repair small fistulas. Distant flaps and graft materials can be used in large defects. The most commonly used oroantral fistula repair techniques and closure methods are buccal flap and palatal flap. Apart from these, buccal fat pads are also very effective in filling and closing the fistula cavity as a local flap.

Technical Detail Description of Oroantral Fistula Closure With Buccal Fat Pad Flap Video

The video above and the photos below are not suitable for patients under the age of 18 because they contain bloody surgical areas.

The procedure was planned under general anesthesia for the patient above, whose tomography photographs were seen. After the local anesthetic was injected, an incision was made into the gingiva. The fistula area was determined. The fistula tract and granulation tissue were circularly scraped with the aid of a curette. The contents of the maxillary sinus were aspirated and washed several times with sterile antibiotic serum containing rifampicin. A flap was prepared from the buccal fat pad and the fistula area was filled with it. It was laid on local mucosal flaps and sutured with 3/0 rapid vicryl and 4/0 vicryl sutures. The patient was advised to avoid vacuuming, blowing and pressure blowing for several weeks.

Below you can see the before and after photos of the surgical procedure: 

Oroantral Fistula Closure With Buccal Fat Pad Flap

Oroantral Fistula Closure With Buccal Fat Pad Flap

Oroantral Fistula Closure With Buccal Fat Pad Flap

One week after the oro-antraf fistula repairing surgery

Oroantral fistula,chronic maxillary sinusitis,OAF,Dental Sinusitis,Odontogenic Sinusitis,

In the photo above, there is an intraoral view 1 week after the oroantral fistula repair. It was observed that the pain due to Odontogenic Sinusitis in the patient's face and teeth was almost completely resolved. It was observed that the self-melting purple-colored slitting materials were still present, it was said that the feeling of discharge from the mouth into the nose of the patient completely disappeared.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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