Tratamiento de comunicaciones bucosinusales y buconasales: Reporte de cinco casos de diferente etiología / Treatment of oroantral and oronasal communications: report of five cases with different etiology

Objetivo: Las comunicaciones bucosinusales y buco- nasales son condiciones patológicas que se caracterizan por la presencia de una solución de continuidad entre la cavidad bucal y el seno maxilar o la cavidad nasal respectivamente. Una vez que se ha instalado una comunicación es deseable ce- rrar este defecto, evitando así la infección del seno maxilar y posibles dificultades en la deglución, fonación y masticación. Se han propuesto diferentes tratamientos para su resolución, algunos no quirúrgicos y otros quirúrgicos. Los quirúrgicos pueden realizarse desplazando tejidos locales, regionales o injertando. El presente trabajo tiene como objetivo presentar situaciones clínicas de comunicaciones bucosinusales y buco- nasales con diferentes etiologías y sus distintos tratamientos según tamaño y ubicación del defecto. Casos clínicos: Se identificaron pacientes que asistie- ron al Servicio de Cirugía Maxilofacial del Hospital Piñero presentando cuatro comunicaciones bucosinusales agudas y crónicas y una comunicación buconasal crónica. Los casos analizados fueron tratados de manera quirúrgica utilizando di- versos colgajos según tamaño y ubicación del defecto (AU)

Aim: Oroantral and oronasal communications are patho- logical conditions characterized by the presence of a solu- tion of continuity between the oral cavity and the maxillary sinus or nasal cavity respectively. Once a communication has been installed, it is desirable to close this defect, thus avoid- ing infection of the maxillary sinus and possible difficulties in swallowing, phonation, and mastication. Different treatments have been proposed for its resolution, some non-surgical and others surgical. Surgical procedures can be performed by dis- placing local or regional tissue or by grafting. The aim of this case report is to present clinical situations of oral sinus and oral nasal communication with different etiologies and their different treatments according to the size and location of the defect. Clinical cases: A group of patients who attended the Maxillofacial Surgery Service of Piñero Hospital presenting four acute and chronic oral sinus and one oronasal communi- cations were identified. The analyzed cases were treated sur- gically using different flaps according to the size and location of the defect (AU)

Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse.

BACKGROUND: Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. CASE REPORT: An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. CONCLUSION: These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.

Sinusitis maxilar iatrogénica por material de impresión dental / Iatrogenic maxillary sinusitis by dental impression material

Introducción: La etiología de la sinusitis maxilar comprende diferentes causas primarias y secundarias. Siempre es preciso descartar de inicio aquellas causas iatrogénicas consecuencia de intervenciones previas. Objetivo: Realizar una revisión de las diferentes causas de sinusitis maxilar, con énfasis en las causas raras iatrogénicas y en el protocolo de actuación. Presentación del caso: Paciente varón de 60 años que presenta episodios de sinusitis maxilar. Como antecedentes quirúrgicos se había realizado quistectomía maxilar, tratamiento de fístula oroantral secundaria y rehabilitación protésica posterior. Tras estudio radiológico inicial se halló una masa intrasinusal, compatible al tacto con material de impresión dental. Conclusiones: Es importante antes de cualquier rehabilitación protésica y de la toma de modelos confirmar la ausencia de fístula oroantral para evitar la intrusión de material extraño en el seno maxilar(AU)

Introduction: The etiology of maxillary sinusitis comprises a number of primary and secondary causes. It is always necessary to initially rule out iatrogenic causes resulting from previous interventions. Objective: Carry out a review of the different causes of maxillary sinusitis, with an emphasis on the rare iatrogenic causes and the clinical management protocols. Case presentation: A male 60-year-old patient who experiences episodes of maxillary sinusitis. Surgical antecedents include maxillary cystectomy, treatment for secondary oroantral fistula and posterior prosthetic rehabilitation. Initial radiological examination revealed an intrasinus mass compatible to the touch with dental impression material. Conclusions: Before any sort of prosthetic rehabilitation and the taking of models, it is important to confirm the absence of an oroantral fistula, to prevent the entrance of foreign material into the maxillary sinus(AU)

Multidisciplinary approaches to odontogenic lesions.

PURPOSE OF REVIEW: To give an overview of technical considerations and relevant literature in the management odontogenic pathology with involvement of the maxillary sinus. RECENT FINDINGS: Infections, cysts, benign neoplasms (odontogenic and nonodontogenic), and inflammatory conditions impact the maxillary sinus in various ways, could result in significant expansion within the maxillary sinus and significant infections. SUMMARY: This manuscript provides an overview of common pathologic entities of the oral cavity proper that impacts the maxillary sinus health, with discussion of the role of the otorhinolaryngologist and the dental specialist.

Comparison of the Clinical Outcomes of Buccal Advancement Flap Versus Platelet-Rich Fibrin Application for the Immediate Closure of Acute Oroantral Communications.

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.

The Use of Platelet-Rich Fibrin for Immediate Closure of Acute Oroantral Communications: An Alternative Approach.

Currently, the buccal advancement flap, palatal rotational flap, and buccal fat pad techniques are frequently used to close an oroantral communication (OAC). In this study, platelet-rich fibrin (PRF) clots were used for immediate closure of acute OACs after extraction of posterior maxillary molars. Acute oroantral perforations larger than 3 mm in diameter in 21 patients were treated uneventfully using PRF clots. None of the patients had systemic diseases or symptoms of sinus disease. After tooth extraction, the diagnosis of acute OAC was examined by the Valsalva maneuver (compressing the nostrils with the fingers and then blowing out air). After detection of an air leak, a modified ball burnisher instrument 3 mm in diameter was used to determine whether the perforation was larger than 3 mm. The postextraction socket of the tooth was cleaned with sterile physiologic saline solution and the cavity was filled with PRF. PRF clots were sutured to the gingiva to prevent them from migrating to the sinus and for stabilization. On the seventh day of follow-up, healthy granulation tissue was observed; during the third week of follow-up, epithelialized oral mucosa was detected at the extraction site in all cases. The use of PRF enables the closure of OACs without primary flap closure or any other surgical interventions. Thus, the use of PRF for immediate closure of acute OACs will make the treatment of OACs less traumatic and easier and will eliminate the need for special surgical expertise.

Alternative method to treat oroantral communication and fistula with autogenous bone graft and platelet rich fibrin.

BACKGROUND: Removing a tooth from the jaw results in the occurrence of oroantral communication in beneficial anatomic conditions or in the case of a iatrogenic effect. Popularized treatments of the oroantral communication have numerous faults. Large bone defect eliminates the chance to introduce an implant. Purpose of this work was assessment of the usefulness of autogenous bone graft and PRF in normal bone regeneration in the site of oroantral communication. MATERIAL AND METHODS: Bone regeneration in the site of oroantral communication was assessed in 20 patients. Bone defects were supplemented autogenous bone graft from mental protuberance in 14 cases and from oblique line in 6 cases. The graft was covered with a PRF membrane. RESULTS: In the study group in all cases closure of the oroantral communication was observed. The average width of the alveolar was 13 mm and the average height was 12.5 mm. In 3 patients an average increase of alveolar height of 1.5 mm was observed. CONCLUSIONS: This method may be the best option to prepare alveolar for new implant and prosthetic solutions.

Cierre de comunicaciones bucosinusales con colgajos palatinos / Closure of oral sinus communications with palatal flaps

Las comunicaciones bucosinusales (CBS) son una condición patológica que se caracteriza por la presencia de una solución de continuidad entre la cavidad bucal y el seno maxilar. Una vez que se ha instalado una CBS es deseable cerrar este defecto, evitando así la infección del seno maxilar y posibles dificultades en la deglución, fonación y masticación. Se han propuesto diferentes tratamientos para su resolución, algunos no quirúrgicos y otros quirúrgicos. Los quirúrgicos pueden realizarsedesplazando tejidos locales, regionales o injertando. El objetivo de este trabajo es mostrar la utilidad del cierre plßsticos local con colgajo palatino. Para ello se muestran dos casos clínicos y se realizó una revisión de la bibliografía con la intensión de clarificar sus ventajas y desventajas...

Oroantral communication (OAC) is a pathological condition characterized by the presence of an abnormal communication between themaxillary sinus and the oral cavity.Once an OAC has established, the closure of this defect is desired in order to avoid infection of the maxillary sinus, and possible difficulties in swallowing, speaking and chewing.Several treatments have been suggested for this condition, both surgical and non surgical. Surgical treatments consist of relocating localor regional tissue and grafting. The purpose of this work is to show the effectiveness of local plastic closure using a palatal flap. Two clinical cases are presented and a revision of literature was performed in order to clarify its advantages and disadvantages...

Conservative management of medication-related osteonecrosis of the maxilla with an obturator prosthesis.

Advanced maxillary medication-related osteonecrosis of the jaw can cause extensive hard and soft tissue destruction that results in long-term oroantral fistulae. The surgical treatment of medication-related osteonecrosis of the jaw may relieve acute symptoms and eliminate the signs of inflammation, but the primary and sustained plastic closure of these defects can challenge both the clinician and the patients. Although the use of obturator prostheses for maxillary defects after ablative oncologic surgery is well documented, studies about this treatment for similar medication-related osteonecrosis of the jaw-related defects are missing. This presentation of clinical situations describes the use of obturators as a conservative alternative to repetitive surgery for the rehabilitation of selected maxillary defects with oroantral communications.

Occult peri-implant oroantral fistulae: posterior maxillary peri-implantitis/sinusitis of zygomatic or dental implant origin. Treatment and prevention with bone morphogenetic protein-2/absorbable collagen sponge sinus grafting.

Sinus floor grafting with bone morphogenetic protein-2 for transsinus implant placement or as a salvage technique for sinus-involved peri-implantitis has been found to be successful. Transsinus implants for All-on-Four treatment, zygomatic implants including quad zygomatics, and infected transsinus implants underwent peri-implant grafting, which was found to seal off the sinus cavity from the oral cavity in an effort to prevent or treat sinusitis/peri-implantitis.

Interdisciplinary treatment of an adolescent with unilateral cleft lip and palate.

AIM: The present case report describes the importance of interdisciplinary approach and gives an understanding on management of an adolescent with unilateral cleft lip and palate. BACKGROUND: Failure of fusion between medial nasal process and maxillary process or between the palatal process leads to the formation of clefts. Clefts are result of genetic or environmental factors or a combination of both. Common dental problems associated with clefts includes anterior and posterior crossbites, hypodontia, malformation and abnormal eruption pattern. CASE REPORT: A girl, aged 15 years reported with a chief complaint of unesthetic appearance of her maxillary anterior teeth. She had unilateral cleft lip and palate and had received cheiloplasty and palatoplasty when she was in young age and rhinoplasty when she was 14 years of age. At pretreatment evaluation, she had concave profile with maxillary arch constriction and oroantral fistula and mesially tipped maxillary left canine. CONCLUSION: This patient's treatment was unconventional, but it was successful in significantly improving her masticatory function and smile, along with favorable dental and facial results. Generalized esthetics and function were significantly improved in this patient without orthognathic surgery, and treatment results were stable 3 years after the appliance removal. Clinical considerations, sequencing of treatment phases as shown in this case report can be utilized while treating an adolescent with cleft lip and palate. CLINICAL SIGNIFICANCE: If the skeletal discrepancy is mild and esthetic concerns are minimal, dental compensation by orthodontic treatment alone might be recommended. The cephalometric analysis and prediction tracings provide further information for deciding whether a patient can be treated by orthodontics alone, or by orthodontics and an orthognathic surgical procedure. A change in axial inclination of the teeth can camouflage the skeletal relationship adequately. However, one should be cautious in a growing patient, because he or she might outgrow the dental correction so that ultimately skeletal surgery would be indicated.

Use of N-butyl cyanoacrylate with metacryloxisulfolane (glubran 2) surgical glue for flapless closure of oroantral communication.

AIM: To present first experience of the use N-butyl cyanoacrylate with metacryloxisulfolane (Glubran 2) synthetic surgical glue, in the nonsurgical closure of oroantral communication (OAC). MATERIAL AND METHODS: Two OACs, created after the exodontia of tooth 27 in 2 female patients, were sealed and closed with Glubran 2 surgical glue and monitored OACs, until the epithelization of the sockets was ended successfully. Two months postclosure of OACs, the sealed OACs were evaluated on the panoramic image and Water's view radiography. RESULTS: The extraction wounds with OACs were monitored until 23rd and 25th postinterventional days, when epithelization of socket ended successfully. On the panoramic image and Water's view radiography, there were no radiological signs of maxillary sinus pathoses. CONCLUSION: Glubran 2 can be successfully applied in the closure of OAC from 3 to 5 mm in diameter.

The use of absorbable polyglactin/polydioxanon implant (Ethisorb(®)) in non-surgical closure of oro-antral communication.

Oro-antral communications (OAC) greater than 4-5 mm in diameter can seldom be counted on to heal spontaneously without the necessity for surgical closure. The initial experience in applying an absorbable polyglactin/polydioxanon implant (Ethisorb(®)), in non-surgical closure of OAC ranging from 5 to 7 mm in diameter, is presented. Twelve patients of varying ages with OAC up to 72 h in duration, have been treated with Ethisorb(®). Failures were not demonstrated in the form of the creation of an oro-antral fistula (OAF), and in all patients, OAC-s were closed with the epithelization of post-extraction wounds up to 21 days after implantation of Ethisorb(®). Based on these initial encouraging results, we propose that an Ethisorb(®) biopolymeric absorbable implant can be used in selected clinical cases for non-surgical closure of OAC.

Oro-antral fistulae and fractured tuberosities.

This paper, in discussing oro-antral fistulae and fractured tuberosities, aims to guide the dentist through the assessment and reduction of risk when removing maxillary molar teeth that are closely related to the maxillary sinus. However, complications are inevitable and the management of these will also be discussed.

A review of oro-antral communications.

Oro-antral communications are occasionally produced during routine oral surgery procedures and often cannot be avoided. Dentistry's emphasis on implantology means that defects in the maxillary sinus are encountered far more frequently than before; therefore, knowledge of the maxillary sinus is of the utmost importance. Unfortunately, many general dentists have not been trained to provide proper treatment to correct these defects. Swift diagnosis and subsequent treatment are vital to proper and successful management. This article reviews the literature and the anatomy of the maxillary sinus and discusses the diagnosis and conservative treatment of oro-antral communications.

Closure of oroantral communications using biodegradable polyurethane foam: a feasibility study.

PURPOSE: The aim of this study was to assess the feasibility of biodegradable polyurethane (PU) foam for closure of oroantral communications (OACs). PATIENTS AND METHODS: Ten consecutive patients with OACs (existing <24 hours) were treated with PU foam. Standardized evaluations were performed at 2 weeks and 8 weeks after closure of the OAC. RESULTS: In 5 patients, the OACs were closed successfully without complications. Three patients developed sinusitis, which was conservatively managed with antibiotics in 2 cases. In 1 case the sinus was reopened for irrigation, after which a buccal flap procedure was performed. In 2 patients the OAC recurred and was surgically closed with a buccal flap after thorough irrigation. CONCLUSION: In this feasibility study, closure was achieved in 7 of the 10 patients without further surgical intervention. Complications of the procedure using PU foam may be related to the fit of the foam in the socket and the size of the perforation. In general, closure of OACs with biodegradable polyurethane foam is feasible and has the potential to spare a large number of patients with OACs a surgical procedure. Furthermore, in case the treatment with PU foam fails to close the OAC, the attending physician can always fall back on the standard surgical procedure.

Nonsurgical closure of oroantral communications with a biodegradable polyurethane foam: A pilot study in rabbits.

PURPOSE: Surgical closure of oroantral communications (OACs) has several disadvantages. An animal study was performed to test whether OACs can be closed nonsurgically with a biodegradable polyurethane (PU) foam. MATERIALS AND METHODS: In 6 rabbits, an OAC was created on both sides of the maxilla. Three rabbits were used to evaluate the animal model by applying a surgical treatment on 1 side and by leaving the other defects untreated. In the 3 other rabbits, OACs were closed with PU foam. Wound healing was evaluated clinically and histologically. RESULTS: The surgically treated defects healed without complications. The untreated defects showed complicated and delayed healing. Healing of the foam-treated OACs was dependent on the type of foam that was used. CONCLUSIONS: The rabbit is a suitable animal model for OAC investigations. It is possible to close an OAC with a biodegradable PU foam. Further research is needed to show the most suitable composition of the PU for this purpose.

Development of an oro-antral fistula following sinus elevation surgery: a case report on management using platelet-rich plasma.

The aim of this case report is to present the use of platelet-rich plasma (PRP) in the management of an oro-antral fistula occurring as a complication of lateral wall sinus augmentation. Currently, platelet-rich plasma is being used in periodontal and oral surgical practices in a wide variety of applications. The patient in this case report developed an oro-antral fistula following sinus augmentation. This was treated using platelet-rich plasma combined with a flap approach. Following clinical healing, three single-stage implants were placed and restored. Clinical and histologic results are discussed in relation to clinical management, wound healing, and regenerative outcomes of treatment. The patient has been followed up for six years.