Comprehensive Management of Oroantral Fistula Secondary to Chronic Maxillary Osteomyelitis: A Case Report

This case report describes the successful management of a rare oroantral fistula (OAF) secondary to chronic osteomyelitis in a 50-year-old woman presenting with persistent right maxillary swelling, purulent discharge, and oroantral communication persisting for six months. The case was complicated by systemic comorbidities and increased susceptibility to infection, with no history of dental extractions or trauma. The initial misdiagnosis of nasal polyps led to an unsuccessful endoscopic sinus surgery. Cone-beam computed tomography revealed extensive osteolytic lesions and buccal bone necrosis, whereas histopathology confirmed chronic osteomyelitis with hypertrophic sinus mucosa. Surgical intervention under general anesthesia involved atraumatic extraction of the affected teeth, debridement of the necrotic bone, excision of the hypertrophic sinus lining, and closure with a buccal advancement flap. Postoperative care included antibiotics and medical optimization of comorbidities, resulting in complete symptom resolution at the one-month follow-up. This case highlights the diagnostic challenges of osteomyelitis-driven OAF and emphasizes the critical role of comprehensive imaging, histopathological confirmation, and a multidisciplinary approach that integrates surgical precision with systemic management of the disease. These successful outcomes underscore the need for tailored strategies to address complex OAFs, particularly in patients with systemic risk factors, to achieve optimal healing and prevent recurrence.