Oroantrat fistula is a commonly encountered clinical problem. As the
diameter of the bony deficiency and elevated air pressure on one or both
sides of the wound are main factors involved in healing of OAF it was
tried in this study to investigate the effects of the use of Bioglass for the
treatment of recurrent oroantral fistula after surgical closure. The study
was conducted on 14 patients having a history suggesting oroantral fistula
after tooth extraction with recurrence after previous surgical closure.
A coronal CT scan was performed to assess the maxillary sinus and to
evaluate the fistula. The Caldwell-Luc operation was performed endoscopically
for the existing sinus pathology. After the treatment of sinus
pathology, a palatal, buccal or buccopatatal flap was created. Scar tissue
and osteitis were removed from the fistuLous tract. The track was
then closed using a piece of Bioglass plate. The piece of the used bioglass
was sculptured using a sharp scalpel or a diamond burr until it becomes
nearly fitted to the track then it was placed inside the track. If there is
any space between the piece of the Bioglass and the outer wall of the
track. The mi icoperiosteal palatalflap is rotated across over the defect.
After 3 months the fistula closed by new bone of nearly the same density
of the adjacent bone in 12 patients. Postoperative radiographs
showed clear sinuses in 12 patients with mildly thickened mucosa at the
floor and adjacent parts of the medial and lateral walls. In 2 patients the
operation was considered as failed. One of those two patients was diabetic.
In the diabetic patient, there was extrusion of the bioglass after 7
days from the wound which healed partially. The sinus drained purulent
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discharge from the wound. The flaps were edematous and swollen at the
site of the fistula. In the other patient the there was marked pain at the
site of the operation, non healing of the flap above the site of the track.
The bioglass plate was loose and got down easily from the wound. Culture
of the purulent discharge of both patients revealed aerobes (Gm positive
streptococci and staphylococci) while in the other diabetic patient,
there was mixture of aerobes and anaerobes. In conclusion, the use of bi-
°glass can be helpful in closure of large recurrent oroantral fistula. It acts
as a barrier preventing oral and maxillary sinus epithelium to cover the
track. It abolishes the elevated pressure in the sinus or oral cavity which
may be a factor of failure of healing of soft tissue closure. It is not only
beneficial for closure of the fistula by new bone formation but also provides
sufficient bone in the alveolar region which may be beneficial for
further placement of osseo-integrated implant and conventional prosthetic
rehabilitation. |
