Abstract:
This study aimed to assess the clinical outcome of a designated approach purpose to reconstruct
large oro-antral fistulae combining tripled layer soft tissue closure along with later sinus lifting and
bone grafting. The study constituted of three non-smokers male patients, which were subjected
to failed previous surgical closures of large oro-antral fistulae, with a subsequent maxillary sinus
infection and morbid vascular bed. After definite eradication of the persisting infection, the large
communications were planned to be restored by three soft tissue flaps, the first of which based on
utilizing the dense epithelial fistulous sinus tract, which was crafted, instead of being eliminated
and adapted to the underlying bony defect to represent a shield that sealed the defect, obliterated
the dead space, withstood the postoperative fluid overload and supported the overlying pedicled
fat pad and the buccal advancement flap, which represented the second and third layers of closure.
Three months later, open sinus lifting and bone grafting of the defects were carried out. Although
two patients complained significant postoperative pain, limitation of mouth opening and swelling,
all the reconstructed defects healed uneventfully, none of them revealed postoperative infection,
wound dehiscence or relapse throughout the investigation period, and the patients neither exhibited
any sign of recurrent maxillary sinusitis nor graft failure, furthermore, C.B.C.T. six months
postoperatively, demonstrated that the reconstructed defects are well organized to receive proper
sized dental implants. The authors recommend implementing this study over a broadened sample
size, as this study was restrained by the small number of participants.
