Comparison of Different Surgical Techniques in the Management of Oroantral Fistula

Oroantral fistula (OAF) is a disease pathology of the oral cavity to the maxillary sinus, which most frequently occurs after the removal of maxillary posterior teeth. Different surgical interventions have been suggested to deal with it, though no agreement has been attained as to the most efficient method in the various clinical conditions. This experiment was to compare clinical results of various surgical methods that are available in management of oroantral fistula. A potential comparative clinical trial was done on 40 patients well balanced in four groups based on the type of surgical process applied to them, which was the buccal advancement flap, palatal rotational flap, buccal fat pad flap, and the combined use of both layers in the process of most closure. The 3-month post-operative evaluation was in terms of clinical success of closure, postoperative pain, healing time, complications, changes of the depth in the patient, and satisfaction. The outcomes demonstrated that total closure was observed in 100.0 and 100.0 percent of the cases in the buccal fat pad and combined technique group respectively, and 90.0 percent in buccal advancement and palatal flap group respectively. The buccal fat pad group showed the best postoperative pain (VAS: 4.77,9 -24 -36 days 1 and 15.97,9 -24 -36 days 7) and the least amount of time to heal (15.8,83 -24 -36 days 1 and 15.97,83 -24 -36 days 7). The buccal advancement flap exhibited the least amount of operative time (31.5 ± 3.0 minutes) and the highest amount of decrease in the depth of the vestibule (3.22 ± 0.28 mm). Palatal flap group had more postoperative pains and took more time to heal (20.1 ± 1.7 days). The buccal fat pad and combined groups showed no recurrence whilst the buccal and palatal flap groups showed recurrence in 10.0%. The patient satisfaction rate was the greatest in the group of the buccal fat pad (8.84 ± 0.23). Within the scope of this paper, the buccal fat pad flap had better overall clinical performance, whereas the combined use of the two-layer technique was very productive in more complicated cases. Consequently, the choice of the surgical method is to be individualized, with regard to defect features and clinical conditions.