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International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3 , April 2014 , Pages 116-119

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 , 3Dr Bhagyashree Purandare

1Head of department, Dept of Oral and , YMT Dental college , Kharghar, Navi Mumbai 2Postgraduate studies, Dept of 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, 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 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 Case Report : A 28 years old healthy male pathological communication between the oral reported to the outpatient department of hospital for cavity and the maxillary sinus; depending on the evaluation of pus discharging fistula distal to left location it can be classified as alveolo-sinusal, upper first molar. The patient gave history of palatal-sinusal and vestibulo-sinusal. 1 Oro-antral traumatic extraction of upper left second molar 2 communications may develop as a complication of months back. He had discomfort in the region of dental extractions, but may also result from the extraction socket. Soon after, expression of a accidental or iatrogenic trauma, neoplasm or yellowish foul smelling discharge followed from infection. 2,3 An oroantral fistula which is smaller the socket, the patient reported for the dental check than 2 mm frequently closes spontaneously. up .The patient reported that the crown was However, when the defect is bigger or when there fractured while extraction. The patient also is , maxillary sinus or periodontal reported of foul smelling discharge from nose region infection, such fistula demands surgical while drinking water. The intra oral examination treatment for its complete closing. 4 This article revealed that the left upper second molar was reports a case of a oro-antral fistula successfully absent. Purulent material from the fistula was treated with a double layer technique using buccal observed distal to left maxillary first molar. A fat pad and buccal advancement flap and removal provisional diagnosis of oro-antral fistula was of displaced roots of molar from the antrum. given based on the history and examination.

116 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3 , April 2014 , Pages 116-119

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 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.

117 International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3 , April 2014 , Pages 116-119

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 rate falls to 67% when the closing is secondary. 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. The advantages of pedicled buccal fat pad

117118 International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3 , April 2014 , Pages 116-119

(BFP) include ease of harvesting, simplicity, more stability, can be used to cover BFP and as versatility, low rate of complications, and quick additional tissue for closure where there is a surgical technique. The blood supply of the buccal deficient BFP for closure. fat pad is not affected due to its displacement, once CONCLUSION it is gripped and replaced between the flap and the The treatment of oronatral fistula through the use maxillary wall. It is worth noting that the use of of buccal advancement flap and buccal fat pad is a BFP with buccal advancement flap (combination simple and complete method which enables several technique) in the literature is scarce. 11,12 It provides 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 journal 6 (2012): 94. 2. Seward GR, Harris M, McGowan DA. Killey and Kay’s Outline of oral surgery 2ed. Bristol: IOP Publishing Ltd; 1987. 3. Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula: experience with 27 cases. Am J Otolaryngol. 2003 Jul-Aug;24(4):221-3 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, 53:771-775. 5. Eppley B, Scfaroff A. Oro-nasal fistula secondary to maxillary argumentation. Int Oral Surg. 1984, 13:535. 6. Stajcic Z. The buccal fat pad in the closure of oro-antral communications - A study of 56 cases. J Craniomaxillofac Surg. 1992, 20:193. 7. Liversedge RL, Wong K. Use of the buccal fat pad in maxillary and sinus grafting of the severely atrophic preparatory to implant reconstruction of the partially or completely edentulous patient: technical note. Int J Oral Maxillofac Implants. 2002 May-Jun;17(3):424-8. 8. 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. 1997 Apr;35(2):81-4. 9. 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. 2000 Feb;58(2):158-63. 10. Samman N, Cheung LK, Tideman H. The buccal fat pad in oral reconstruction. Int J Oral Maxillofac Surg. 1993 Feb;22(1):2-6. 11. Fujimura N, Nagura H, Enomoto S. Grafting of the buccal fat pad into palatal defects. J Craniomaxillofac Surg. 1990;18:219–22. 12. 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

117119 www.ijhbr.com ISSN: 2319-7072 International J. of Healthcare and Biomedical Research, Volume: 2, Issue: 3 , April 2014 , Pages 116-119

117 www.ijhbr.com ISSN: 2319-7072