A pedicled buccal periosteal flap for the closure of oro-antral fistula.

BACKGROUND: An oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis. PURPOSE: This study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure. PATIENTS & METHODS: Patients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined radiographically using computed tomography preoperatively. All patients underwent surgical closure of oroantral fistula using a pedicled buccal periosteal flap. RESULTS: All 10 patients obtained satisfactory results with marked improvement in the function of the maxillary sinus and complete healing of oroantral fistula with no recurrence except in Case No. 5, who had a recurrence of the oroantral fistula, also there was no statistically significant difference between the vestibular depth preoperatively and postoperatively. CONCLUSION: A pedicled buccal periosteal flap is a novel technique for oroantral fistula closure as it preserves vestibular depth with a tension-free closure flap and harbors the advantages of the regenerative potential of the periosteum. REGISTRATION DATE: 14/8/2023 REGISTRATION NUMBER: NCT05987943.

[Maxillary sinusitis as a complication of dental implants placement: a case report]. / Verkhnechelyustnoi sinusit kak oslozhnenie dental'noi implantatsii: sluchai iz praktiki.

The article presents a case of chronic odontogenic maxillary sinusitis and the results of its surgical treatment. The cause of the sinusitis, confirmed by the results of X-ray and pathohistological studies, was an inflammatory process affecting the bone tissue around the implant, installed in the place of the upper first molar which was accompanied by the development of an oroantral fistula. During the surgical intervention, the communication between the oral cavity and the maxillary sinus was eliminated, and the implant with the abutment, which was entirely in its cavity, was also removed.

A Novel Approach for the Treatment of Recurrent Oroantral Fistula Occurring at an Infected Sinus Augmentation Site.

Closing a recurrent oroantral fistula (OAF) that occurs at an infected sinus augmentation site is a challenge for clinicians. The recurrent OAF has a detrimental impact on bone regeneration and subsequent implant placement. This case report includes three cases in which sinus graft infection and OAF occurred after maxillary sinus augmentation (MSA). In these cases, treatments to control sinus infection were performed using an otolaryngologist; then, intraoral interventions comprising mucosal flap procedures, bone grafts, and barrier membrane applications were performed 2-5 times by oral surgeons. Nevertheless, OAF recurred persistently. The failure to stop OAF recurrence may be due to the inability to effectively block air pressure at the OAF site. Following a comprehensive debridement of the infected tissue at the previous sinus augmentation site, a pouch was created through sinus mucosal elevation. The perforated sinus mucosa at the OAF site was covered with a non-resorbable membrane in one case and with resorbable collagen membranes in the other two cases, followed by bone grafting within the pouch. Lastly, this procedure was completed by blocking the entrance of the pouch with a cortical bone shell graft and a resorbable collagen membrane. The cortical bone shell graft, obstructing the air pressure from the nasal cavity, facilitated bone formation, and, ultimately, allowed for implant placement. Within the limitations of the present case report, the application of a guided bone regeneration technique involving a cortical bone shell graft and a barrier membrane enabled the closure of the recurrent OAF and subsequent implant placement.

Prefabricated CAD-CAM scaffolds for management of oro-antral communication: A case report and histological analysis.

INTRODUCTION: Oro-control communication is one of the complications associated with dental extraction and oral surgeries. This case report presents a minimally invasive surgical approach for bone regeneration at the site of oro-antral communication utilizing a prefabricated computer-aided design and computer-aided manufacturing (CAD-CAM) allogenic bone block. METHODS: A 20-year-old healthy female, nonsmoker, with a badly destructed upper right first molar was referred for dental implant placement after extraction. Cone beam computerized tomography images revealed the presence of a large bone defect associated with oro-antral communication with the maxillary sinus and insufficient bone for dental implant placement. A prefabricated CAD-CAM allogenic bone scaffold was fabricated. After surgical exposure, the scaffold was secured in place and covered with a non-resorbable membrane. A dental implant was placed after 5 months, and a trephining biopsy was processed for histological evaluation. RESULTS: Closure of the oro-antral communication was clinically observed. The average width of the alveolar bone was 12 mm, and the average height was 11 mm. Histological analysis at 5-month intervals showed thin newly formed bone trabeculae encircling remnants of graft material surrounded by osteoid tissue. The newly formed bone percentages were 32 ± 18% and 28 ± 17% volume remained after the biodegradation of the scaffold. Specific immune-histochemical staining by anti-vascular epithelial growth factor expression index value was 32.06%. CONCLUSIONS: A prefabricated CAD-CAM scaffold was successfully used to seal a large oro-antral communication and regenerate sufficient bone to place a dental implant.

Which method is successful in closureof acute oroantral communication? A retrospective study / ¿Qué método tiene éxito en el cierre de la comunicación oroantral aguda? Un estudio retrospectivo

Background: This study's purpose is to retrospectively evaluate the success of surgical methods used in treatingOroantral Communication (OAC).Material and Methods: This study was designed as a retrospective cohort study on patients who developed OACafter surgery maxillary posterior region. The records of patients previously treated with OAC were scannedthrough the hospital registry software. A data set was created by recording patients' age, gender, systemic dis-ease, etiological reasons, and surgical methods. The primary predictor variable was the surgical method usedto treat OAC. Other variables were age, gender, systemic disease and etiological reasons. The primary outcomewas oroantral fistula development after the first surgical intervention. The patients who were positive in clinicalexamination and Valsalva test on control days were considered unsuccessful. One-way analysis of variance andKruskal-Wallis tests were used for quantitative variables in more than two groups. Pearson chi-square test wasused to compare categorical data.Results: This retrospective cohort study was completed with 605 patients who met the study criteria among 95,883patients who underwent surgery in the maxillary posterior region. The incidence of OAC was 0.63%. The patientsconsisted of 238 female and 367 male patients. The mean age was 41.06±14.48 years. Buccal flap and Buccal FatPad methods were used most frequently in the treatment. While treatment was completed with the first surgicalintervention in 592 (97.85%) patients, OAF developed in 13 (2.15%) patients. No statistically significant relationexisted between surgical technique and OAF development (p>0.005). The success rate of the Buccal Flap methodwas 98.7%, and the Buccal Fat Pad method was 95.8%.(AU)

The use of Titanium Meshes in Surgical Closure of the Oroantral Fistula. A Randomized Clinical Trial Study.

The closure of oroantral communications (OACs) is challenging. The study aimed to assess the effect of titanium meshes in the outcome of OAC closure by local flaps. This is a prospective randomized, nonblinded clinical trial. Patients with a delay and large (≥7 mm 2 ) OAC were studied. Patients were randomly divided into 2 groups: in group 1, patients underwent OAC closure through a modified Rehrmann buccal advancement flap with a titanium mesh, and in group 2, the modified Rehrmann buccal advancement flap. The primary predictive factor was the use of titanium mesh. Dehiscence (the breakdown of the edge of flaps without the complete reopening of the defect) was a primary outcome. The defect's reopening was considered a secondary outcome. Nineteen patients in group 1 and 20 in group 2 were studied. In 2 months after treatments, the prevalence of dehiscence in group 1 was 3, and 10 patients in group 2 ( P =0.041). In group 1, patients did not show OAC exposure. However, OAC exposure was observed in 2 patients in group 2. This study demonstrates that using titanium mesh in combination with a modified Rehman flap decreases the prevalence of dehiscence compared with a flap alone.

Odontogenic maxillary sinusitis associated with foreign body displacement after tooth extraction: report of an unusual case / Sinusite maxilar odontogênica por corpo estranho após extração dentária: relato de um caso incomum

Background: Odontogenic maxillary sinusitis caused by a foreign body presents diagnostic and therapeutic challenges due to its infrequent occurrence and unique characteristics compared to sinusitis originating from other sources. CaseReport:Illustrating such fact, this report presents the clinical case of a 37-year-old woman referred complaining of pain in the same region where she had extracted her upper right first molar five days before. The intraoral examination revealed the presence of an orifice in the region, suggesting oroantral communication. Imaging exams revealed opacification of the right maxillary sinus and the unexpected presence of a highly radiodense object. With the diagnosis of maxillary sinusitis due to a foreign body established, the surgical approach initially consisted of administering preoperative medication, preceded by access to the maxillary antrum using the Caldwell-Luc technique. The object was found and removed, consisting of a surgical drill. At follow-up there was complete absence of symptoms and complete closure of communication. Conclusion: Cases of odontogenic maxillary sinusitis caused by drill detachment after tooth extraction are fairly uncommon. A thorough clinical evaluation proved to be essential and the Caldwell-Luc access was effective, safe and with good postoperative results, even with the absence of standardized diagnostic and management methods(AU)

Contexto: A sinusite maxilar odontogênica causada por corpo estranho apresenta desafios diagnósticos e terapêuticos devido à sua ocorrência infrequente e características únicas em comparação com sinusites originadas de outras fontes. Relato do Caso: Ilustrando tal fato, este relato apresenta o caso clínico de uma mulher de 37 anos de idade encaminhada com queixa de dor em mesma região que havia extraído o primeiro molar superior direito cinco dias antes. Ao exame intraoral verificou-se a presença de um orifício na região, sugerindo comunicação oroantral. Os exames de imagem revelaram opacificação do SM direito e a inesperada presença de um objeto altamente radiodenso. Com o diagnóstico de sinusite maxilar por corpo estranho estabelecido, a abordagem cirúrgica consistiu inicialmente na administração de medicação pré-operatória, precedida pelo acesso ao antro maxilar através da técnica de Caldwell-Luc. O objeto foi encontrado e removido, consistindo em uma broca cirúrgica. Ao acompanhamento houve ausência completa dos sintomas e total fechamento da comunicação. Conclusão: Casos de sinusite maxilar odontogênica causada por descolamento da broca após extração dentária são bastante incomuns. Uma avaliação clínica minuciosa mostrou-se primordial e o acesso de Caldwell-Luc eficaz, seguro e com bons resultados pós-operatórios, mesmo com as ausências de métodos de diagnóstico e manejo padronizados.(AU)

Which method is successful in closure of acute oroantral communication? A retrospective study.

BACKGROUND: This study's purpose is to retrospectively evaluate the success of surgical methods used in treating Oroantral Communication (OAC). MATERIAL AND METHODS: This study was designed as a retrospective cohort study on patients who developed OAC after surgery maxillary posterior region. The records of patients previously treated with OAC were scanned through the hospital registry software. A data set was created by recording patients' age, gender, systemic disease, etiological reasons, and surgical methods. The primary predictor variable was the surgical method used to treat OAC. Other variables were age, gender, systemic disease and etiological reasons. The primary outcome was oroantral fistula development after the first surgical intervention. The patients who were positive in clinical examination and Valsalva test on control days were considered unsuccessful. One-way analysis of variance and Kruskal-Wallis tests were used for quantitative variables in more than two groups. Pearson chi-square test was used to compare categorical data. RESULTS: This retrospective cohort study was completed with 605 patients who met the study criteria among 95,883 patients who underwent surgery in the maxillary posterior region. The incidence of OAC was 0.63%. The patients consisted of 238 female and 367 male patients. The mean age was 41.06±14.48 years. Buccal flap and Buccal Fat Pad methods were used most frequently in the treatment. While treatment was completed with the first surgical intervention in 592 (97.85%) patients, OAF developed in 13 (2.15%) patients. No statistically significant relation existed between surgical technique and OAF development (p>0.005). The success rate of the Buccal Flap method was 98.7%, and the Buccal Fat Pad method was 95.8%. CONCLUSIONS: The results of this study showed that noninvasive methods in openings smaller than 5 mm and surgical treatment methods in openings larger than 5 mm have a high success rate with the limitations of present study.

Is an Attachable Oral Wound Dressing Effective at Closing an Acute Oroantral Communication?

BACKGROUND: An oroantral communication (OAC) is an acute opening after tooth extractions in the posterior maxilla that requires immediate closure. The search for a noninvasive and cost-effective OAC treatment method remains ongoing. PURPOSE: This study assessed the effect of oral wound dressing (OWD) on acute OACs of 2-5 mm and compared it with suturing sterile gauze (SG) and plasma-rich fibrin (PRF). STUDY DESIGN, SETTING, AND SAMPLE: A randomized, double-blind clinical trial was conducted at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Erciyes University. The sample included patients aged >18 years, a 2-5 mm wide OAC without previous maxillary sinus pathology or surgical operation. PREDICTOR VARIABLE: The primary predictor variable was the closure method used: OWD, SG, or PRF. OWD is a new produced and commercially available product that has been used for closure of oral wounds after periodontal or surgical interventions. MAIN OUTCOME VARIABLE: The primary outcome variable was OAC closure on postoperative day 30. The secondary outcomes were procedure duration and the pain scores of postoperative days 1, 3, and 7. COVARIATES: The covariates were age and sex. ANALYSES: Quantitative variables were compared between groups using the Kruskal-Wallis test. Qualitative variables were analyzed between groups using the Pearson's χ2 test. Results with a P value <.05 were considered statistically significant. RESULTS: This study included 60 patients (30 females and 30 males). Clot formation was uneventful on postoperative days 1, 3, and 7 in all patients. OAC closure was successful in all patients on postoperative day 30. The success rate of OAC closure did not differ significantly between groups (P > .05). The surgical procedure duration was significantly shorter in the OWD group (1.2 ± 0.41 min) than in the SG (5.75 ± 0.97 min) and PRF (19.65 ± 2.74 min) groups (P < .001). Verbal analog scale scores differed significantly among the OWD (1.05 ± 1.43), SG (4.35 ± 2.85), and PRF (2.5 ± 1.82) groups on postoperative day 1 (P < .001). CONCLUSION AND RELEVANCE: OWD is a less invasive and practical method for closing OACs.

Functional rehabilitation of the maxillary sinus after modified endoscopic sinus surgery for displaced dental implants.

PURPOSE: Dental implants may become displaced into the maxillary sinus due to insufficient primary stability, changes in nasal air pressure, or surrounding bone resorption and should be removed as soon as possible. The aim of this study was to evaluate the efficacy of the modified endoscopic sinus surgery (MESS) approach for removal of displaced dental implants. METHODS: From September 2010 to November 2021, we studied 15 cases with displaced implants in the maxillary sinus. The patient characteristics, medical history, clinical and imaging results, and post-removal outcomes were retrospectively assessed. RESULTS: The symptoms included sinusitis (100%), pain (26.6%), postnasal drip (6.6%), nasal obstruction (26.6%), and oroantral communication (26.6%). Two cases were managed through the crestal approach (13.3%), while two cases were treated with the Caldwell-Luc procedure (13.3%). One case was addressed using functional endoscopic sinus surgery (6.7%), while 10 cases were managed with the MESS approach (66.7%). MESS allows functional rehabilitation of mucociliary clearance by the cilia in the sinus membrane. Implant displacement into the maxillary sinus can be classified as early, late, or delayed displacement. CONCLUSIONS: MESS is a reliable treatment option that can identify migrated dental implants in any part of the sinus with endoscopic assistance for functional rehabilitation of the maxillary sinus without postoperative sequelae.

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)

Oroantral Communications: Clinical Efficacy of a Double-layered Technique With/Without the Palatal Connective Tissue Flap: A Superiority, Single-center, University-based Randomized Clinical Trial.

The aim of this study was to compare the clinical results of combining a pedicle connective palatal flap coupled with the trapezoid buccal flap against the buccal flap alone in the closure of the oroantral fistula. Individuals with oroantral communication were consecutively included and eventually randomly allocated into 2 groups. In the group test, oroantral fistula was treated with the association of a buccal flap with a pedicle palatal connective tissue flap; in group control, a classic buccal sliding flap was performed. Patients' outcomes were recorded at 48 hours, 1 week, 2 weeks, and 1 month after surgery for assessment of primary (success rate) and secondary endpoints, such as experienced pain, discomfort, and complications. The success rate was 96.6% for the test group and 86.6% for the control group. No significant difference between the 2 groups could be observed regarding discomfort and pain. More pronounced pain was detected in the test group during the early healing period. This surgical procedure was demonstrated to be successful, with a high success rate and low patient discomfort.

Odontogenic Sinusitis with Oroantral Communication and Fistula Management: Role of Regenerative Surgery.

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.

A Study of Two Novel Techniques for One-stage Closure of Chronic Oroantral Fistula and Sinus Floor Lift.

PURPOSE: This study aimed to compare two novel techniques for chronic oroantral fistula (OAF) closure combined with maxillary sinus floor elevation. MATERIALS AND METHODS: Ten patients who had implant installation needs but suffered from a chronic OAF were enrolled in the study from January 2016 to June 2021. The technique applied involved OAF closure and simultaneous sinus floor elevation by either a transalveolar or lateral window approach. Bone graft material evaluation results, postoperative clinical symptoms and complications were compared between the two groups. Student's t -test and χ 2 test were used to analyze the results. RESULTS: In this study, 5 patients with a chronic OAF were treated with the transalveolar approach (group I), and 5 were treated with the lateral window approach (group II). The alveolar bone height was significantly higher in group II than in group I ( P ＜0.001). The pain at 1 day ( P =0.018) and 3 days ( P =0.029) postoperatively and facial swelling at 7 days ( P =0.016) postoperatively were obviously greater in group II than in group I. There were no severe complications in either group. CONCLUSIONS: The techniques combined OAF closure with sinus lifting to reduce surgical frequency and risks. The transalveolar approach resulted in milder postoperative reactions, but the lateral approach could provide more bone volume.

Successful Management of Late Sinus Graft Infection via Functional Endoscopic Sinus Surgery and Press-Fit Block Bone Graft: A Case Report.

The purpose of this case report is to feature an interesting case where a staged approach was used to manage a failed implant site that led to a late sinus graft infection and sinusitis with an oroantral fistula (OAF), by using functional endoscopic sinus surgery (FESS) and an intraoral press-fit block bone graft technique. Sixteen years ago, a 60-year-old female patient underwent maxillary sinus augmentation (MSA) with 3 implants placed simultaneously in the right atrophic ridge. However, No. 3 and 4 implants were removed due to advanced peri-implantitis. The patient later developed purulent discharge from the site, headache, and complained of air leakage due to an OAF. The patient was referred to an otolaryngologist for FESS to treat the sinusitis. Two months after FESS, the sinus was re-entered. Residual inflammatory tissues and necrotic graft particles in the OAF site were removed. A block bone harvested from the maxillary tuberosity was press-fitted to the OAF site and grafted. After 4 months of grafting, the grafted bone was well incorporated with the surrounding native bone. Two implants were successfully placed in the grafted site with good initial stability. The prosthesis was delivered 6 months after implant placement. After the 2 years of follow-up, patient was functioning well without sinus complications. Within limitation of this case report, the staged approach via FESS and intraoral press-fit block bone graft is an effective method that can be used to successfully manage OAF and vertical defects at the implant site.

Platelet-rich fibrin vs. buccal advancement flap for closure of oroantral communications: a prospective clinical study.

OBJECTIVES: The primary aim was to evaluate the success of the defect closure (tight or open) of oroantral communications (OAC) after treatment with platelet-rich fibrin (PRF) clots or a buccal advancement flap (BAF). Secondary outcome measurements were the evaluation of the wound healing, the displacement of the mucogingival border (MGB), and the pain level. MATERIAL AND METHODS: Fifty eligible patients with an OAC defect larger than 3 mm were randomly assigned to either PRF (test group, n = 25) or BAF (control group, n = 25) for defect closure. In a prospective follow-up program of 21 days, the defect closure healing process, the wound healing course using Landry's wound healing index (score: 0-5), the displacement of the MGB, and the postoperative pain score were evaluated. RESULTS: Five patients in each group were lost to follow-up resulting in 40 patients (20 in each group) for continuous evaluation. On postoperative day 21 (study endpoint), no difference regarding success rate (defined as closure of OAC) was noticed between the test (90%; 18/20) and control group (90%; 18/20). A univariate analysis showed significant differences for age and defect size/height for the use of PRF between successful-tight and open-failed defect healing. At the final evaluation, a significantly (p = 0.005) better wound healing score, a lower displacement of the MGB as well as lower pain-score were seen for the use of PRF. CONCLUSIONS: Based on the findings of the current study, the use of platelet-rich fibrin represents a reliable and successful method for closure of oroantral communications. The use of PRF clots for defect filling is associated with lowered pain levels and less displacement of the mucogingival border. CLINICAL RELEVANCE: The defect size should be taken into account when choosing the number and size of PRF plugs.

Appropriate Implant Rehabilitation in Patients With Iatrogenic Oroantral Fistula and Odontogenic Maxillary Sinusitis.

Oroantral fistula (OAF) is the most common etiology for odontogenic maxillary sinusitis that can be caused by tooth extractions, failed maxillary sinus lifts, bone grafts, and poor positioning of dental implant fixtures. A 52-year-old man presented with an OAF and maxillary sinusitis after implant placement and bone grafting. The authors treated the patient with modified endoscopic sinus surgery to obtain OAF closure and provided dental implant placement procedures afterward. The authors also treated 8 other similar cases with favorable outcomes. In this study, the authors report the know-how of implant placement procedures in patients with OAF and maxillary sinusitis.

Subperiosteal inferior maxillectomy in mucormycosis patients: case series.

OBJECTIVE: Mucormycosis is a rapidly progressive and fulminant fungal infection mainly affecting the nose and paranasal sinuses and often requiring aggressive surgical debridement, which commonly includes inferior maxillectomy. Conventional inferior maxillectomy involves removal of the bony hard palate and its mucoperiosteum. This can lead to formation of an oroantral fistula and thereby increase the morbidity in these patients leading to prolonged rehabilitation. Subperiosteal inferior maxillectomy involves sparing of the uninvolved mucoperiosteum of the hard palate. This flap is used for closure of the oroantral fistula, which preserves the functional capabilities of the patient, such as speech, mastication and deglutination. METHOD: This case series describes the experience of using the technique of mucosa-preserving subperiosteal inferior maxillectomy in five patients with mucormycosis. RESULTS: With the technique used in this study, complete oronasal separation was achieved in all six patients. The overall surgery time was also decreased when compared with free tissue transfer. Patients also did not have to bear the weight of prosthesis. CONCLUSION: Mucoperiosteal palatal flap-preserving subperiosteal inferior maxillectomy is an excellent approach for all patients with mucormycosis and healthy palatal mucosa.

Foreign Bodies in Sinonasal Tissues: A Potential Pitfall yet a Hint to Oroantral Fistulas.

Foreign bodies in the maxillary sinus are infrequent findings with various organic and inorganic materials have been reported. Most are iatrogenic due to abnormal communications between the oral cavity and the sinus cavity, predominantly secondary to dental and oral procedures. Oroantral fistulas might be asymptomatic incidental findings or may present with sinusitis-related symptoms. Even though oroantral fistulas are frequently encountered iatrogenic complications, most studies focused on radiologic findings and surgical closure procedures. A few cases reported the histopathologic findings of foreign body-related antral sinusitis. Our aim is to report three cases of chronic maxillary sinusitis induced by various foreign bodies of oral and dental origin associated with oroantral fistulas. Our focus is to highlight the different histopathologic patterns, potential pitfalls and helpful clues of foreign body-induced maxillary sinusitis. Altered foreign bodies in procured sinus specimens might be missed, misinterpreted or ignored by pathologists. Obvious vegetable food remnants were detected, but subtle vegetable residuals showed pulse granuloma, rings and sheet-like patterns embedded in the granulation tissue and fibrous stroma. Some materials mimicked fungal hyphae while others were ignored as nonspecific debris. Periodic acid Schiff stain and polarizing light helped delineate their nature. Other helpful hints included the presence of oral-type squamous epithelium, crystals, hemosiderin pigments, dental materials such as alvogyl, and microorganisms of oral origin for example Actinomyces. Our series emphasizes the importance of correct recognition of foreign bodies of oral and dental origin in paranasal specimens to guide clinicians to the possibility of oroantral fistula-associated odontogenic sinusitis versus conventional rhinosinusitis.

Oroantral Fistula Closure Using Double-Layered Flap: Greater Palatine Artery Flap and Buccal Fat Pad.

A novel surgical technique based on a combined approach to oroantral fistula closure using a double-layered flap: greater palatine artery pedicled flap and buccal fat pad combination. Laryngoscope, 133:1824-1827, 2023.