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. 2024 Apr 10;24(1):440.
doi: 10.1186/s12903-024-04217-6.

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

Marwa T Ibrahim  1 , Eslam A Gharieb  2 , Mona S Sheta  3
Affiliations

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

Marwa T Ibrahim et al. BMC Oral Health. .

Abstract

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.

Keywords: Maxillary sinus; Oroantral fistula; Pedicled buccal periosteal flap.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow chart
Fig. 2
Fig. 2
(A) Panoramic X-ray film demonstrating an oroantral fistula associated with the extracted upper left first molar. (B&C) A sagittal and coronal CT scan of the extraction site reveals an oroantral fistula, Case No. 2
Fig. 3
Fig. 3
(A) Preoperative photograph of an oroantral fistula (B) incision and reflection of buccal mucosal flap, (C) bony defect related to the oroantral fistula of upper left first molar, (D) reflection of periosteal flap from the underlying bone, (E) suturing of the periosteal flap over the oroantral fistula, (F) suturing of the buccal mucosa to the palatal tissue, Case No. 2
Fig. 4
Fig. 4
(A) Preoperative panoramic X-ray film (B) Preoperative photograph showing the vestibular depth of buccal sulcus before extraction of upper left first molar (C) Incision of buccal mucosal flap, (D) Reflection of the flap showing bony defect related to the oroantral fistula of upper first molar, (E, F,G) Dissection of periosteal flap from the overlying buccal mucosa, (H) Suturing of the periosteal flap over the oroantral fistula, (I) Suturing of the buccal mucosa to the palatal tissue with preservation of vestibular depth (J) Postoperative panoramic X ray, Case No 9
Fig. 5
Fig. 5
(A) Two weeks postoperatively showing slight inflammation at the surgical site (B) One month postoperatively showing adequate healing of oroantral fistula with preservation of vestibular depth, (C) Three months postoperatively buccal view and (D) occlusal view showing preservation of vestibular depth, Case No 9
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