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ABSTRACT Many options are exercised to affect surgical management of oroantral fistulae. Postoperative wound dehiscence is not uncommon, and the surgical management of such fistulae often becomes increasingly difficult because of a lingering maxillary sinus infection. This was a retrospective study done on 23 patients in which a double layered technique, consisting of buccal fat pad in conjunction with buccal advancement flap was used for surgical closure of oroantral fistulae. Only 3 of the patients had had a failure of the closure. We recommend this technique because of its many advantages and low risk of complications.
Key Words: Minor oral surgery, dental extractions complications, buccal fat pad flap, oroantral fistula.
INTRODUCTION Oroantral communication is not an infrequent complication of dental extraction in the upper buccal region. Continued pneumatization of the alveolar portion of the maxilla by the maxillary sinus leads to a close proximity of the dental roots of especially the maxillary first molar, but also the maxillary second and third molars, premolars and sometimes the maxillary canine.1 Extraction leads to the formation of a small communication, with or without the displacement of the dental root into the maxillary sinus. Host of effects follow, the notable of which include regurgitation of oral fluids into the sinus and nasal cavity, foul smelling discharge from the site of the communication, inability to build oral pressure and possibly sinusitis.2 While most cases of small oroantral communica- tions can be managed relatively easily by adhering to sinus precautions and possibly prescribing an antral regime, established cases of oroantral fistulae require surgical closure of the defect. This is accomplished by a thorough excision of the lining epithelium of the fistula, and then using most of the times a local flap to affect closure over the bony defect. Common flaps to accomplish this closure include buccal advancement flap, buccal fat pad flap, buccal advancement closure over a metal foil, palatal rotation flap and palatal is- land flaps.3 Larger flaps including temporalis and free tissue transfer might be required for larger fistulae, as resulting from ablative surgery or traumatic loss of posterior maxilla. This is done under an antibiotic cover, nasal decongestants and possibly anti histamines.2 The most common complication of such a closure is wound dehiscence, and an ideal flap...