A CASE REPORT OF ORO ANTAL FISTULA TREATED WITH A COMBINATION TECHNIQUE OF BUCCAL ADVANCEMENT FLAP AND BUCCAL FAT PAD

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1 Case Report: A CASE REPORT OF ORO ANTAL FISTULA TREATED WITH A COMBINATION TECHNIQUE OF BUCCAL ADVANCEMENT FLAP AND BUCCAL FAT PAD 1 Dr Gopal Sharma, 2 Dr Jaya Mukherjee, 3 Dr Bhagyashree Purandare 1Head of department, Dept of Oral medicine and Radiology, YMT Dental college, Kharghar, Navi Mumbai 2Postgraduate studies, Dept of Oral medicine and Radiology, YMT Dental college, Kharghar, Navi Mumbai 3Postgraduate studies, Dept of Oral medicine and Radiology, YMT Dental college, Kharghar, Navi Mumbai Corresponding author : Dr Jaya Mukherjee Abstract : The oroantral fistula (OAF) is a pathological communication between the oral cavity and the maxillary sinus; depending on the location it can be classified as alveolo-sinusal, palatal-sinusal and vestibulo-sinusal. Oro-antral communications may develop as a complication of dental extractions, but may also result from accidental or iatrogenic trauma, neoplasm or infection. An oroantral fistula which is smaller than 2 mm frequently closes spontaneously. A 28 years old healthy male reported to the outpatient department of hospital for evaluation of pus discharging fistula distal to left upper first molar. A surgery was planned for the removal of displaced root segments and closure of the fistula. A Caldwell luc approach was used to remove the roots and the closure of oro antral fistula was done by using double layer technique with buccal fat pad and a buccal advancement flap. The sutures were then placed. The treatment of oronatral fistula through the use of buccal advancement flap and buccal fat pad is a simple and complete method which enables several uses in most of cases. Keywords : Coroantral fistula Introduction : The oroantral fistula (OAF) is a pathological communication between the oral cavity and the maxillary sinus; depending on the location it can be classified as alveolo-sinusal, palatal-sinusal and vestibulo-sinusal. 1 Oro-antral communications may develop as a complication of dental extractions, but may also result from accidental or iatrogenic trauma, neoplasm or infection. 2,3 An oroantral fistula which is smaller than 2 mm frequently closes spontaneously. However, when the defect is bigger or when there is inflammation, maxillary sinus or periodontal region infection, such fistula demands surgical treatment for its complete closing. 4 This article reports a case of a oro-antral fistula successfully treated with a double layer technique using buccal fat pad and buccal advancement flap and removal of displaced roots of molar from the antrum. Case Report : A 28 years old healthy male reported to the outpatient department of hospital for evaluation of pus discharging fistula distal to left upper first molar. The patient gave history of traumatic extraction of upper left second molar 2 months back. He had discomfort in the region of the extraction socket. Soon after, expression of a yellowish foul smelling discharge followed from the socket, the patient reported for the dental check up.the patient reported that the crown was fractured while extraction. The patient also reported of foul smelling discharge from nose while drinking water. The intra oral examination revealed that the left upper second molar was absent. Purulent material from the fistula was observed distal to left maxillary first molar. A provisional diagnosis of oro-antral fistula was given based on the history and examination. 116

2 International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3, April 2014, Pages The patient was advised for a orthopantomograph with displacement of two roots into maxillary OPG and cone beam computed tomography CBCT. sinus. The radiographs revealed oro antral communication FIG 1- PREOPERATIVE A surgery was planned for the removal of displaced root segments and closure of the fistula. A Caldwell luc approach was used to remove the roots and the closure of oro antral fistula was done by using double layer technique with buccal fat pad and a buccal advancement flap. The sutures were then placed. FIG 2- SURGERY FOR CLOSURE OF FISTULA Routine postoperative instructions with prescription of antibiotics and analgesics were given to the patient. The patient was warned against blowing the nose for 2 weeks. The post operative CBCT showed maxillary antrum clear of the root stumps.

3 International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3, April 2014, Pages FIG 3 POSTOPERATIVE The patient was followed-up for duration of 2 months periodically at the regular intervals to evaluate for any postoperative complication. Complete epithelisation was observed after 6 weeks. No post operative complications were evident. I FIG 4-POSTOPERATIVE HEALING DISCUSSION buccal fat pad is an encapsulated, rounded, The primary closing of oro-antral fistulas in 48 biconvex specialized fatty tissue which is distinct hours presents a 90 to 95% success rate, and such from subcutaneous fatty tissues. It is located 5,6 between the buccinator muscle medially, the Numerous surgical methods have been described anterior margin of the masseter muscle and the for treatment of oro antral fistulas, although only a mandibular ramus and zygomatic arch laterally few have been accepted in daily practice. The 7,8,9,10. rate falls to 67% when the closing is secondary. The advantages of pedicled buccal fat pad 118

4 (BFP) include ease of harvesting, simplicity, versatility, low rate of complications, and quick surgical technique. The blood supply of the buccal fat pad is not affected due to its displacement, once it is gripped and replaced between the flap and the maxillary wall. It is worth noting that the use of BFP with buccal advancement flap (combination technique) in the literature is scarce. 11,12 It provides more stability, can be used to cover BFP and as additional tissue for closure where there is a deficient BFP for closure. CONCLUSION The treatment of oronatral fistula through the use of buccal advancement flap and buccal fat pad is a simple and complete method which enables several uses in most of cases. REFERENES 1. Borgonovo, Andrea Enrico, Frederick Valerio Berardinelli, Marco Favale, and Carlo Maiorana. "Surgical Options In Oroantral Fistula Treatment." The open dentistry journal 6 (2012): Seward GR, Harris M, McGowan DA. Killey and Kay s Outline of oral surgery 2ed. Bristol: IOP Publishing Ltd; Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula: experience with 27 cases. Am J Otolaryngol Jul-Aug;24(4): Hanazawa Y, Itoh K, Mabashi T, Sato K. Closure of oro-antral communications usig a pedicled buccal fat pad graft. J oral Maxillof Surg. 1995, 53: Eppley B, Scfaroff A. Oro-nasal fistula secondary to maxillary argumentation. Int Oral Surg. 1984, 13: Stajcic Z. The buccal fat pad in the closure of oro-antral communications - A study of 56 cases. J Craniomaxillofac Surg. 1992, 20: Liversedge RL, Wong K. Use of the buccal fat pad in maxillary and sinus grafting of the severely atrophic maxilla preparatory to implant reconstruction of the partially or completely edentulous patient: technical note. Int J Oral Maxillofac Implants May-Jun;17(3): Martin-Granizo R, Naval L, Costas A, Goizueta C, Rodriguez F, Monje F, et al. Use of buccal fat pad to repair intraoral defects: review of 30 cases. Br J Oral Maxillofac Surg Apr;35(2): Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP. The use of the buccal fat pad for reconstruction of oral defects: review of the literature and report of 15 cases. J Oral Maxillofac Surg Feb;58(2): Samman N, Cheung LK, Tideman H. The buccal fat pad in oral reconstruction. Int J Oral Maxillofac Surg Feb;22(1): Fujimura N, Nagura H, Enomoto S. Grafting of the buccal fat pad into palatal defects. J Craniomaxillofac Surg. 1990;18: Batra H, Jindal G, Kaur S. Evaluation of different treatment modalities for closure of oro-antral communications and formulation of a rational approach. J Maxillofac Oral Surg. 2010;9:13 8. Date of submission: 21 January 2014, Date of provisional acceptance: 14 Feb 2013 Date of Final acceptance: 22 March 2014 Date of Publication: 07 April 2014 Source of support: Nil; Conflict of interest: Nil 119

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