J Korean Assoc Oral Maxillofac Surg.  2023 Jun;49(3):163-168. 10.5125/jkaoms.2023.49.3.163.

The double-barrier technique using platelet-rich fibrin for closure of oroantral fistulas

• Jung JW
• Hong So
• Lee EJ
• Kim RY
• Jee YJ

• KMID: 2544320
• DOI: http://doi.org/10.5125/jkaoms.2023.49.3.163

Abstract

An oroantral fistula (OAF) or oroantral communication (OAC) is an opening between the oral cavity and the maxillary sinus. If left untreated, these openings may cause chronic maxillary sinusitis. Although small defects (diameter <5 mm) may close spontaneously, larger communications require surgical intervention. Various studies have been conducted on OAC closure using a platelet-rich fibrin (PRF) membrane; most of these prior studies have involved simple direct application of PRF clots. This study introduces a new “double-barrier technique” using PRF for closure of an OAF involving sinus mucosal lifting and closure. The PRF material is inserted into the prepared maxillary sinus space, and the buccal advancement flap covers the oral side. This technique was successfully used to treat two patients with chronic OAF in the posterior maxillary region after implant removal or tooth extraction. The use of a PRF membrane in a double-barrier technique may have advantages in soft-tissue healing and could enable easy closure of chronic OAF with minimal trauma.

Keyword

Oroantral fistula; Oroantral communication; Platelet-rich fibrin; Double-barrier technique; Oral defect

Figure

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  Fig. 1 A schematic of the incision line (A), antral flap rotation and elevation as the first barrier (B), platelet-rich fibrin (PRF) insertion into the prepared maxillary sinus space (C), a buccal advancement flap as the second barrier (D).

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  Fig. 2 A. A pre-surgery panoramic radiograph of Patient No. 1. B. The cone-beam computed tomography view. C. A view of the oroantral fistula from the oral side. D. The view of the elevated and sutured sinus mucosa. E. A view of the platelet-rich fibrin clots inserted as a membrane. F. The view of the sutured buccal advancement flap. G. A view from the oral side at two weeks postoperatively. H. A view from the oral side at two months after surgery.

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  Fig. 3 A. A pre-surgery panoramic radiographs of Patient No. 2. B. The cone-beam computed tomography view. C. A view of the oroantral fistula from the oral side. D. The view of the elevated sinus mucosa. E. A view of the platelet-rich fibrin clots inserted as a membrane. F. The view of the sutured buccal advancement flap. G. A view from the oral side at two weeks postoperatively. H. A view from the oral side at two months after surgery.

Reference

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