Search Results (20)

Background/Objectives: Oroantral fistulas (OF) are a challenging complication in oral and maxillofacial surgery, often requiring surgical intervention to restore sinus integrity. The Bichat’s buccal fat pad (BFP) has gained attention as a viable option for OF closure. This study aimed to evaluate the efficacy, safety, and clinical outcomes of BFP advancement for OF treatment. Methods: This prospective study included 20 patients diagnosed with OF. The surgical procedure involved isolation and advancement of the BFP to close the defect. Patients were followed up at 7 days, 45 days, and 6 months postoperatively, with clinical and radiographic assessments. The primary outcome was successful fistula closure at 6 months, while secondary outcomes included complication rates, sinus opacification on CT scans, pain levels, and quality of life improvements. Results: The overall success rate was 85.7%, with complete fistula closure achieved in 18 out of 21 cases (including one bilateral case). Minor complications occurred in 14.3% of cases. CT scans at 6 months showed complete resolution of sinus opacification in 81% of cases. Patients reported significant improvements in pain scores and quality of life. Conclusions: BFP advancement is an effective, safe, and minimally invasive technique for OF closure, offering high success rates and favorable clinical and radiographic outcomes. These findings support the use of BFP as a reliable option for managing OF in oral and maxillofacial surgery. Full article

Aim: This study aims to evaluate the management of oro-antral communications (OAC) and fistulas (OAF), focusing on treatment strategies based on defect size, epithelialization, and the presence of sinus infections, while exploring both traditional and emerging techniques. Materials and Methods: The systematic review was conducted following the PRISMA guidelines and registered on PROSPERO (CDR ID 623251). Using targeted keywords, articles in English published within the last 10 years were analyzed from databases such as PubMed, WoS and Scopus, selecting only clinical studies on human patients. After thorough screening, 20 publications were included in the qualitative analysis, among 734 initially identified. Results: Small OACs (<5 mm) were managed conservatively with hemostatic materials, while larger defects (>5 mm) required surgical closure, with the Bichat flap proving highly effective for large defects. Innovative treatments using autologous bone grafts and PRF showed promise in supporting tissue regeneration. In cases with sinusitis, the combination of FESS and intra-oral closure techniques resulted in high success rates for infection resolution and defect closure. Conclusions: Treatment outcomes for OAC and OAF are highly dependent on the size of the defect and the presence of sinusitis. Multidisciplinary collaboration, along with timely surgical intervention and adherence to medical therapies, is essential for successful management. Emerging techniques and minimally invasive procedures continue to improve patient outcomes, offering hope for more effective and sustainable solutions in complex cases. Full article

The formation of an oroantral communication (OAC) or fistula (OAF) is a rare complication resulting from the presence of processes in the lateral parts of the maxilla or for iatrogenic reasons. The most common causes of OAC or OAF are tooth extraction with periapical lesions. The aims of this systematic review were to assess the use of platelet-derived preparations rich in growth factors in the treatment of OAC or OAF, to determine the success of treating the communication or fistula, as well as impact on postoperative complications and the course of healing. The study was performed following PRISMA guidelines (PROSPERO: CRD42024570758). The inclusion criteria were as follows: at least ten patients, the presence of oroantral communication or oroantral fistula, treatment with platelet-derived preparations rich in growth factors, and information regarding the response to treatment. In order to find relevant studies, international databases, including PubMed, Google Scholar, Web of Science Core Collection, MDPI, Wiley, and Cochrane Library were searched. The last search was performed on 31 August 2024. Seven articles were included in the systematic review. In total, platelet-derived preparations rich in growth factors were used in 164 patients. Only studies in which OAC was treated and with platelet-rich fibrin (PRF) met the inclusion criteria. Only PRF was used as the sole treatment method in three studies. When OAC is greater than 5 mm, platelet-derived preparations rich in growth factors should be considered adjuncts to treatment, not the sole treatment method. The success rate of OAC treatment was 90–100%. The use of blood products to close OAC may be an effective therapeutic alternative. Proper patient qualification and the use of an appropriate protocol are crucial. There is a need for future well-designed case-control or cohort studies as well as randomized controlled trials to provide the required level of evidence. Full article

Objectives: The aim of this work was to systematically review and carry out a statistical metanalysis to identify the best treatment for close oroantral communications and fistulas and to avoid the risk of recurrence. Materials and Methods: An electronic search was conducted on the MEDLINE database (Pubmed), Scopus, and Google scholar using the following keywords: “oro antral communication (OAC)” OR “oro antral fistula (OAF)” OR “antro-oral communication” OR “communication between maxillary sinus and oral cavity” OR “oro-sinusal communication” OR “oro-sinusal fistula” OR “sinus communication” OR “sinus fistula” OR “antral communication” AND “treatment” OR “management” OR “surgical treatment” OR “surgical interventions”. This work was performed in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). After article screening, 9 RCTs (randomized controlled trials), comparing two or more techniques, were included in this review. Results: A statistically significant difference was detected in favor of the buccal fat pad compared to the buccal advancement flap and palatal rotational flap. Conclusions: With the limitations of this study, the buccal fat pad showed the best results in terms of communication closure and reducing the risk of relapse. Full article

Chronic odontogenic maxillary sinusitis (COMS), a prolonged inflammation of the maxillary sinus lasting over 12 weeks, is often a result of periapical lesions, marginal periodontitis, and complications like oro-antral communication (OAC) and fistula (OAF). OAC, commonly emerging post-teeth extraction in the lateral maxilla, lacks documented treatments using advanced platelet-rich fibrin (A-PRF). This study evaluates A-PRF’s efficacy in treating COMS and immediately sealing extensive OAC. A case of a 28-year-old male with COMS linked to a periapical lesion and supernumerary molars is presented. Treatment involved extracting specific teeth while preserving adjacent ones and using A-PRF for immediate OAC closure. A-PRF, enriched with growth factors, was pivotal in healing, showcasing enhanced tissue regeneration, pain reduction, and faster recovery. The findings suggest A-PRF as an effective adjunct in treating extensive OAC and COMS, proposing its inclusion in standard treatment protocols. This study underscores A-PRF’s potential in improving outcomes for patients with COMS and related complications. Full article

Background and Objectives: There are many surgical techniques for oroantral communication treatment, one of which is the buccal fat pad. Of particular interest is the high reparative potential of the buccal fat pad, which may be contributed to by the presence of mesenchymal stem cells. The purpose of this work is to evaluate the reparative potential of BFP cells using morphological and immunohistochemical examination. Materials and Methods: 30 BFP samples were provided by the Clinic of Maxillofacial and Plastic Surgery of the Russian University of Medicine (Moscow, Russia) from 28 patients. Morphological examination of 30 BFP samples was performed at the Institute of Clinical Morphology and Digital Pathology of Sechenov University. Hematoxylin–eosin, Masson trichrome staining and immunohistochemical examination were performed to detect MSCs using primary antibodies CD133, CD44 and CD10. Results: During staining with hematoxylin–eosin and Masson’s trichrome, we detected adipocytes of white adipose tissue united into lobules separated by connective tissue layers, a large number of vessels of different calibers, as well as the general capsule of BFP. The thin connective tissue layers contained neurovascular bundles. Statistical processing of the results of the IHC examination of the samples using the Mann–Whitney criterion revealed that the total number of samples in which the expression of CD44, CD10 and CD133 antigens was confirmed was statistically significantly higher than the number of samples where the expression was not detected (p < 0.05). Conclusions: During the morphological study of the BFP samples, we revealed statistically significant signs of MSCs presence (p < 0.05), including in the brown fat tissue, which proves the high reparative potential of this type of tissue and can make the BFP a choice option among other autogenous donor materials when eliminating OAC and other surgical interventions in the maxillofacial region. Full article

(1) Background: The demands of patients for aesthetic and functional rehabilitation of edentulous areas led to the use of dental implants as therapeutic means on an increasingly large scale. This aspect determined the appearance of some infectious pathologies with a peri-implant starting point that can be complicated by various sinus diseases. The purpose of this review article is to synthesize the existing information in the specialized literature regarding the existing correlations between peri-implant and maxillary sinusitis. (2) Methods: The articles published in five databases were researched using different combinations of search terms. We selected 12 articles from the 250 found, by applying the inclusion and exclusion criteria and removing duplicates. (3) Results: We analyzed the included studies and we found that all of them reported a positive correlation between maxillary sinusitis and peri-implant infectious diseases. There are also reported other pathologies with a peri-implant infectious disease as a starting point such as abscesses, oro-antral communications, or foreign body reactions due to implant or bone graft materials migration. (4) Conclusions: This scoping review highlighted the existence of correlations between peri-implant and sinus pathology and the importance of preventing peri-implant diseases of an infectious nature to avoid the occurrence of these complications. Full article

The buccal fat pad, also called the Bichat’s fat pad (BFP), is an encapsulated fat mass located in the cheek. This type of specialized fat mass can be used both as a pedicular or free graft in various surgeries and approaches. Due to its easy access from the oral cavity approach, it is commonly used for oroantral and palatal fistula closure. The knowledge of its anatomy and surrounding tissues plays a role in its mobilization and suturing onto the desired defect in the palatal or maxillary region. The BFP is mostly associated with the primary approach used for a fistula or bone surgery. Alternatively, the procedure can be performed with a single approach incision, which does not compromise the appearance or the function of the operating or adjacent areas. The most important inclusion criteria for BFP usage and surgical limitations are highlighted. The BFP is used for multiple purposes in reconstructive and oncology surgery and also has its use in esthetic and facial contouring procedures. The amount, volume, and shape of the BFP are mostly associated with the scope of their usage. The aim of the following narrative review is to present the surgical and anatomical implications of fat pads in maxillary and palatal surgeries. Full article

Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life. Full article

Recent reports on secondary restorations with subperiosteal implants have demonstrated promising results in terms of esthetic and functional restoration. We report the case of a reconstruction of a total maxillectomy with a custom-made subperiosteal implant associated with a temporal muscle flap in a patient who could not undergo bone reconstruction with a free flap. This technique made it possible to restore the division between the oral cavity and the mouth, providing a solid anchorage to the dental prosthesis and correcting an oroantral communication with a small palatal obturator. The subperiosteal implant also granted proper soft tissue support in the middle-third of the face. Subperiosteal implants can be safe and effective even in primary maxillary reconstructions for patients who cannot undergo free bone flap reconstructions. In these difficult cases, this type of implant can provide support to the soft tissues of the middle-third of the face and a solid anchorage for dental prostheses or palatal obturators, thus improving the quality of life for patients. Full article

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. Full article

Introduction: an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large defects and underlying general conditions. Bichat fad pad flap is a multipotent pedicled fatty tissue that is easily accessible from the oral cavity that can be used for the closure of medium-sized defects, even in immunocompromised patients due to its stem cell capacity. Materials and methods: the medical information of the patients diagnosed with oro-antral communications who were admitted and treated in the Oral and Maxillo-Facial Clinic Targu Mures, between 2013 and 2020 were analyzed. A database containing general information, reported causes, associated diseases, surgical methods used during admission, and relapses, was created. The information was statistically processed. The written consent and ethical approval were obtained. Results: the study shows that from a total of 140 cases, 72 were treated using buccal advancement flap, 49 using Bichat fat pad flap, and 19 using palatal flaps. The dimensions of the communications ranged between 0.3 cm and 1.5 cm. Several statistically significant results could be found when comparing the surgical methods. Of the 72 patients treated with buccal advancement flaps, 25 presented relapses as opposed to the patients treated with Bichat fat pad flaps who showed no complications, p < 0.05. Analysing this aspect further, all large defects (10 cases) ranging from 0.6 cm to 1.5 cm treated with advancement buccal flaps (Rehrmann flaps) showed relapses (p < 0.05). Considering the general conditions, out of 7 patients who received radiotherapy 4 presented relapses, as opposed to the healthy patients, p < 0.05. Regarding the reintervention for the relapsed cases, the majority of the cases treated a second time with buccal advancement flap (5 out of 7 cases) failed as opposed to the Bichat fat pad flap with no further relapses (p < 0.05). Conclusions: the most frequently used surgical treatment is the buccal flap, which also has the highest relapse rate. Both primary treatment with Bichat fat-pad flap and re-treatment of relapses using this flap have had 100% success rates, even in patients with general associated conditions, in contrast with patients treated by using the buccal flap. The dimensions of the oro-antral communication and general conditions are crucial factors for the success of the surgical treatment. Full article

Background: Oro-antral communication (OAC) is a common complication following the extraction of upper molar teeth. The Archer and the Root Sinus (RS) systems can be used to classify impacted teeth in panoramic radiographs. The Archer classes B-D and the Root Sinus classes III, IV have been associated with an increased risk of OAC following tooth extraction in the upper molar region. In our previous study, we found that panoramic radiographs are not reliable for predicting OAC. This study aimed to (1) determine the feasibility of automating the classification (Archer/RS classes) of impacted teeth from panoramic radiographs, (2) determine the distribution of OAC stratified by classification system classes for the purposes of decision tree construction, and (3) determine the feasibility of automating the prediction of OAC utilizing the mentioned classification systems. Methods: We utilized multiple supervised pre-trained machine learning models (VGG16, ResNet50, Inceptionv3, EfficientNet, MobileNetV2), one custom-made convolutional neural network (CNN) model, and a Bag of Visual Words (BoVW) technique to evaluate the performance to predict the clinical classification systems RS and Archer from panoramic radiographs (Aim 1). We then used Chi-square Automatic Interaction Detectors (CHAID) to determine the distribution of OAC stratified by the Archer/RS classes to introduce a decision tree for simple use in clinics (Aim 2). Lastly, we tested the ability of a multilayer perceptron artificial neural network (MLP) and a radial basis function neural network (RBNN) to predict OAC based on the high-risk classes RS III, IV, and Archer B-D (Aim 3). Results: We achieved accuracies of up to 0.771 for EfficientNet and MobileNetV2 when examining the Archer classification. For the AUC, we obtained values of up to 0.902 for our custom-made CNN. In comparison, the detection of the RS classification achieved accuracies of up to 0.792 for the BoVW and an AUC of up to 0.716 for our custom-made CNN. Overall, the Archer classification was detected more reliably than the RS classification when considering all algorithms. CHAID predicted 77.4% correctness for the Archer classification and 81.4% for the RS classification. MLP (AUC: 0.590) and RBNN (AUC: 0.590) for the Archer classification as well as MLP 0.638) and RBNN (0.630) for the RS classification did not show sufficient predictive capability for OAC. Conclusions: The results reveal that impacted teeth can be classified using panoramic radiographs (best AUC: 0.902), and the classification systems can be stratified according to their relationship to OAC (81.4% correct for RS classification). However, the Archer and RS classes did not achieve satisfactory AUCs for predicting OAC (best AUC: 0.638). Additional research is needed to validate the results externally and to develop a reliable risk stratification tool based on the present findings. Full article

Oroantral communication (OAC) is a common complication after tooth extraction of upper molars. Profound preoperative panoramic radiography analysis might potentially help predict OAC following tooth extraction. In this exploratory study, we evaluated n = 300 consecutive cases (100 OAC and 200 controls) and trained five machine learning algorithms (VGG16, InceptionV3, MobileNetV2, EfficientNet, and ResNet50) to predict OAC versus non-OAC (binary classification task) from the input images. Further, four oral and maxillofacial experts evaluated the respective panoramic radiography and determined performance metrics (accuracy, area under the curve (AUC), precision, recall, F1-score, and receiver operating characteristics curve) of all diagnostic approaches. Cohen’s kappa was used to evaluate the agreement between expert evaluations. The deep learning algorithms reached high specificity (highest specificity 100% for InceptionV3) but low sensitivity (highest sensitivity 42.86% for MobileNetV2). The AUCs from VGG16, InceptionV3, MobileNetV2, EfficientNet, and ResNet50 were 0.53, 0.60, 0.67, 0.51, and 0.56, respectively. Expert 1–4 reached an AUC of 0.550, 0.629, 0.500, and 0.579, respectively. The specificity of the expert evaluations ranged from 51.74% to 95.02%, whereas sensitivity ranged from 14.14% to 59.60%. Cohen’s kappa revealed a poor agreement for the oral and maxillofacial expert evaluations (Cohen’s kappa: 0.1285). Overall, present data indicate that OAC cannot be sufficiently predicted from preoperative panoramic radiography. The false-negative rate, i.e., the rate of positive cases (OAC) missed by the deep learning algorithms, ranged from 57.14% to 95.24%. Surgeons should not solely rely on panoramic radiography when evaluating the probability of OAC occurrence. Clinical testing of OAC is warranted after each upper-molar tooth extraction. Full article

The aim of this study was to identify the most relevant dental factors and iatrogenic causes in the development of pathological changes to the sinus membrane and to analyse their possible influence on the development of odontogenic sinusitis. A descriptive, observational study was designed, with 276 patients who had been evaluated via cone beam computed tomography, analysing possible sinus thickening factors, such as apical infections, endodontic treatments, periodontitis, radicular cysts and impacted teeth, as well as iatrogenic factors caused by implant treatments or the development of oroantral communications produced during tooth extraction manoeuvres. Among the dental factors, periodontitis (47.1%), apical pathology (23.5%) and endodontic treatments (23.1%) were the predominant causes of sinus membrane thickening that most frequently produced an occupancy between 2 and 10 mm. Regarding the implant treatments, the placement of implants through the floor of the maxillary sinus was the main cause (9.8%), followed by sinus elevation techniques (6.2%). Dental extraction was the first cause of oroantral communication (5.0%), being the procedure that caused the greatest thickening of the sinus membrane. This study highlights the importance of dental treatments and iatrogenic factors in sinus pathology, and the need for diagnostic interrelations between the different specialists who address this pathology. Full article