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Sinus bone grafting for oral antral fistulae
4 Letter to the Editor
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY January 2004
retrograde fill with primary closure performed by an experienced provider and a traumatic upper molar extraction which results in a patent oral-antral communication. In retrospect, it would have been prudent to use the words “patent oral-antral communication” when describing our recommendations for antibiotic and decongestant coverage in these patients. Thanks to Dr. Walton for helping us clarify this important issue! David P. Kretzschmar, DDS, MS Wake Forest University School of Medicine
Sinus bone grafting for oral antral fistulae To the editor: As further evidence for the very fine technique elucidated by Dr. Haas, et al (Oral Surg Oral Med Oral Path Oral Radiol Endo 2003;96:263-6), I submit a simple case example that demonstrates that standard sinus grafting from a lateral approach can be done using particulate autograft harvested from the tibia as a treatment for oral antral fistulae. The fistula must be removed and the wound closed primarily following at least a 10mm sinus membrane elevation with graft placement. A bone expander is not recommended. In the case shown here, several surgical procedures, including Caldwell-Luc, were done to repair the oral antral fistula; all procedures failed. The pre-operative panorex revealed loss of bone and a thickened sinus membrane (Fig. 1). The post-surgical CT scan taken 3 months after sinus bone graft (Fig. 2) demonstrates sinus membrane continuity and ongoing bone graft consolidation. The fistula did not reoccur. An interposed cortical bone graft used to close an oral antral fistula has merit. However, cortical pieces of bone used as a “plug” technique can dislodge, and fixation may be required. A simple sinus elevation graft, despite perforation to the sinus membrane, is
Fig 1. Film showing proximity of sinus floor to socket where fistula was previously.
Fig 2. Film after performing sinus lift procedure on same patient at site of fistula.
another alternative for the repair of oral antral fistula, and it is one that I prefer. Ole T. Jensen, DDS, MS, PC Private Practice Denver, Colorado
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY January 2004
retrograde fill with primary closure performed by an experienced provider and a traumatic upper molar extraction which results in a patent oral-antral communication. In retrospect, it would have been prudent to use the words “patent oral-antral communication” when describing our recommendations for antibiotic and decongestant coverage in these patients. Thanks to Dr. Walton for helping us clarify this important issue! David P. Kretzschmar, DDS, MS Wake Forest University School of Medicine
Sinus bone grafting for oral antral fistulae To the editor: As further evidence for the very fine technique elucidated by Dr. Haas, et al (Oral Surg Oral Med Oral Path Oral Radiol Endo 2003;96:263-6), I submit a simple case example that demonstrates that standard sinus grafting from a lateral approach can be done using particulate autograft harvested from the tibia as a treatment for oral antral fistulae. The fistula must be removed and the wound closed primarily following at least a 10mm sinus membrane elevation with graft placement. A bone expander is not recommended. In the case shown here, several surgical procedures, including Caldwell-Luc, were done to repair the oral antral fistula; all procedures failed. The pre-operative panorex revealed loss of bone and a thickened sinus membrane (Fig. 1). The post-surgical CT scan taken 3 months after sinus bone graft (Fig. 2) demonstrates sinus membrane continuity and ongoing bone graft consolidation. The fistula did not reoccur. An interposed cortical bone graft used to close an oral antral fistula has merit. However, cortical pieces of bone used as a “plug” technique can dislodge, and fixation may be required. A simple sinus elevation graft, despite perforation to the sinus membrane, is
Fig 1. Film showing proximity of sinus floor to socket where fistula was previously.
Fig 2. Film after performing sinus lift procedure on same patient at site of fistula.
another alternative for the repair of oral antral fistula, and it is one that I prefer. Ole T. Jensen, DDS, MS, PC Private Practice Denver, Colorado