Surgical Management of Oroantral Communications
Summary
Oroantral communications (OACs) and their chronic form, oroantral fistulas (OAFs), arise most frequently after extraction of posterior maxillary teeth or removal of implants and may lead to persistent maxillary sinus infections if left untreated. Management depends primarily on defect size, sinus health and the duration of epithelialisation. Small openings under 5 mm may close spontaneously or with conservative measures such as haemostatic agents and careful postoperative care. Larger defects typically require surgical closure. Classic techniques include the buccal advancement flap, palatal rotation flap and the pedicled buccal fat pad (Bichat) flap. Choice of flap is guided by defect dimensions, location and patient factors such as general health or prior radiotherapy. More recently, adjunctive regenerative materials—autologous platelet concentrates, collagen barrier membranes and bone grafts—have been introduced to enhance tissue regeneration and reduce relapse. Endoscopic approaches to restore sinus ventilation and drainage, often combined with intraoral closure, have improved infection control in cases complicated by chronic sinusitis. A multidisciplinary approach involving oral surgeons, otolaryngologists and radiologists is crucial to tailor interventions, minimise complications and enable subsequent rehabilitation, including implant placement when indicated.
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Surgical Management of Oroantral Communications publication trend
The graph below shows the total number of articles in surgical management of oroantral communications across all publications each year (not limited to Nature Index journals).
Technical terms
Oroantral communication (OAC): a pathological opening between the oral cavity and maxillary sinus.
Oroantral fistula (OAF): a persistent, epithelialised tract linking the sinus and oral cavity.
Buccal advancement flap: a mucoperiosteal flap raised from the cheek vestibule to close intraoral defects.
Bichat fat pad flap: a pedicled adipose flap harvested from the buccal fat pad, suited to medium and large defects.
Platelet‐rich fibrin (PRF): an autologous fibrin scaffold enriched with platelets and growth factors to support tissue regeneration.
References
- Treatment of Odontogenic Maxillary Sinusitis with the Use of Growth Factors in Advanced Platelet-Rich Fibrin for Immediate Closure of Oro-Antral Communication: A Case Report. International Journal of Molecular Sciences (2024).
- Management of Oro-Antral Communication: A Systemic Review of Diagnostic and Therapeutic Strategies. Diagnostics (2025).
- Decision-making in closure of oroantral communication and fistula. International Journal of Implant Dentistry (2019).
- Selecting the Best Surgical Treatment Methods in Oro-Antral Communications. International Journal of Environmental Research and Public Health (2022).
- Implant Placement after Closure of Oroantral Communication by Sinus Bone Graft Using a Collagen Barrier Membrane in the Shape of a Pouch: A Case Report and Review of the Literature. Medicina (2021).
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