Dentaltown August 2017 - 64

Fig. 1: Patient preop
Panorex from 2015. Note
hyperpneumatized maxillary
sinus and long endodontically
treated roots for #14, with
minimal bone between the
root apices and maxillary
sinus floor.

Fig. 2: Oral/antral fistula, left posterior
maxilla.

Fig. 3: Corrected mirror view demonstrating
left oral/antral fistula, left posterior maxilla.
Fig. 4: Patient Panorex
from 2017. Note
hyperpneumatized
maxillary sinus, with
disruption in alveolar bone
continuity in left maxilla.

Continued from p. 62
I prefer using the buccal fat pad because it
has a robust blood supply. It is essentially an
axial pattern flap supplied by the maxillary
artery (buccal and deep temporal branches),
superficial temporal artery (transverse facial
branches) and facial artery (small branches
from the buccinator artery). The buccal
fat pad can easily cover defects of this size
and provides for a living tissue foundation
to overlay with a second layer of tissue via
the mucosal advancement flap.
Classic anatomic descriptions describe
the buccal fat pad as having a central body
with four processes: buccal, pterygoid,
pterygopalatine and temporal (superficial
and temporal). More recent descriptions
describe the buccal fat pad having three
lobes-anterior, intermediate and posterior-
that are encapsulated and have supporting
ligaments along with their arterial supply.
The buccal and zygomatic branches of the
facial nerve as well as the parotid duct are
lateral to the buccal fat pad. Care must be
taken during surgery to avoid injuring these
structures during surgical dissection.

The procedure

Fig. 5: Coronal, sagittal, axial and 3-D reconstruction views of
oral/antral communication. Extent of defect outlined in red.

Fig. 6: Axial, panoramic reconstruction, coronal sections and 3-D reconstruction
views of oral/antral communication. Extent of defect outlined in red.

64

AUGUST 2017 // dentaltown.com

On the day of surgery, the treatment
plan was reviewed in detail again with the
patient, including the risks, benefits, indications and alternative treatments. Informed
consent was witnessed and signed. He was
given a preoperative rinse of 0.12 percent
chlorhexidine oral rinse and directed to
swish for 1 minute, then spit.
Local anesthesia was provided using four
carpules of 4 percent septocaine with 1:100,000
epinephrine (6.8ml, 272mg septocaine,
0.068mg epinephrine) to provide left posterior
superior alveolar, middle superior alveolar,
greater palatine and V2-division blocks along
with supplemental local infiltration.
An incision was performed along the
alveolar crest with caution to approach
the fistula site, anticipating a much larger
defect extending from the visible fistula.
A distal/buccal releasing incision over the
tuberosity and an anterior releasing incision
were performed. Subperiosteal dissection was
performed at both ends of the latter, with



http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown August 2017

Dentaltown August 2017 - Intro
Dentaltown August 2017 - Cover1
Dentaltown August 2017 - Cover2
Dentaltown August 2017 - 1
Dentaltown August 2017 - 2
Dentaltown August 2017 - 3
Dentaltown August 2017 - 4
Dentaltown August 2017 - 5
Dentaltown August 2017 - 6
Dentaltown August 2017 - 7
Dentaltown August 2017 - 8
Dentaltown August 2017 - 9
Dentaltown August 2017 - 10
Dentaltown August 2017 - 11
Dentaltown August 2017 - 12
Dentaltown August 2017 - 13
Dentaltown August 2017 - 14
Dentaltown August 2017 - 15
Dentaltown August 2017 - 16
Dentaltown August 2017 - 17
Dentaltown August 2017 - 18
Dentaltown August 2017 - 19
Dentaltown August 2017 - 20
Dentaltown August 2017 - 21
Dentaltown August 2017 - 22
Dentaltown August 2017 - 23
Dentaltown August 2017 - 24
Dentaltown August 2017 - 25
Dentaltown August 2017 - 26
Dentaltown August 2017 - 27
Dentaltown August 2017 - 28
Dentaltown August 2017 - 29
Dentaltown August 2017 - 30
Dentaltown August 2017 - 31
Dentaltown August 2017 - 32
Dentaltown August 2017 - 33
Dentaltown August 2017 - 34
Dentaltown August 2017 - 35
Dentaltown August 2017 - 36
Dentaltown August 2017 - 37
Dentaltown August 2017 - 38
Dentaltown August 2017 - 39
Dentaltown August 2017 - 40
Dentaltown August 2017 - 41
Dentaltown August 2017 - 42
Dentaltown August 2017 - 43
Dentaltown August 2017 - 44
Dentaltown August 2017 - 45
Dentaltown August 2017 - 46
Dentaltown August 2017 - 47
Dentaltown August 2017 - 48
Dentaltown August 2017 - 49
Dentaltown August 2017 - 50
Dentaltown August 2017 - 51
Dentaltown August 2017 - 52
Dentaltown August 2017 - 53
Dentaltown August 2017 - 54
Dentaltown August 2017 - 55
Dentaltown August 2017 - 56
Dentaltown August 2017 - 57
Dentaltown August 2017 - 58
Dentaltown August 2017 - 59
Dentaltown August 2017 - 60
Dentaltown August 2017 - 61
Dentaltown August 2017 - 62
Dentaltown August 2017 - 63
Dentaltown August 2017 - 64
Dentaltown August 2017 - 65
Dentaltown August 2017 - 66
Dentaltown August 2017 - 67
Dentaltown August 2017 - 68
Dentaltown August 2017 - 69
Dentaltown August 2017 - 70
Dentaltown August 2017 - 71
Dentaltown August 2017 - 72
Dentaltown August 2017 - 73
Dentaltown August 2017 - 74
Dentaltown August 2017 - 75
Dentaltown August 2017 - 76
Dentaltown August 2017 - 77
Dentaltown August 2017 - 78
Dentaltown August 2017 - 79
Dentaltown August 2017 - 80
Dentaltown August 2017 - 81
Dentaltown August 2017 - 82
Dentaltown August 2017 - 83
Dentaltown August 2017 - 84
Dentaltown August 2017 - 85
Dentaltown August 2017 - 86
Dentaltown August 2017 - 87
Dentaltown August 2017 - 88
Dentaltown August 2017 - 89
Dentaltown August 2017 - 90
Dentaltown August 2017 - 91
Dentaltown August 2017 - 92
Dentaltown August 2017 - 93
Dentaltown August 2017 - 94
Dentaltown August 2017 - 95
Dentaltown August 2017 - 96
Dentaltown August 2017 - Cover3
Dentaltown August 2017 - Cover4
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-january-2024
https://www.nxtbook.com/farran/dentaltown/dentaltown-december-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-november-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-new-grad-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-october-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-september-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-august-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-july-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-june-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-may-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-january-2023
https://www.nxtbook.com/farran/dentaltown/dentaltown-december-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-november-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-october-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-new-grad-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-september-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-august-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-july-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-june-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-may-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-january-2022
https://www.nxtbook.com/farran/dentaltown/dentaltown-december-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-november-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-new-grad-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-october-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-september-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-august-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-july-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-june-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-may-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-april-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-march-2021
https://www.nxtbook.com/farran/dentaltown/dentaltown-february-2021
https://www.nxtbook.com/farran/dentaltown/2021January
https://www.nxtbook.com/farran/dentaltown/2020December
https://www.nxtbook.com/farran/dentaltown/2020November
https://www.nxtbook.com/farran/dentaltown/2020NewGrad
https://www.nxtbook.com/farran/dentaltown/2020October
https://www.nxtbook.com/farran/dentaltown/2020September
https://www.nxtbook.com/farran/dentaltown/2020August
https://www.nxtbook.com/farran/dentaltown/2020July
https://www.nxtbook.com/farran/dentaltown/2020June
https://www.nxtbook.com/farran/dentaltown/2020May
https://www.nxtbook.com/farran/dentaltown/2020April
https://www.nxtbook.com/farran/dentaltown/2020March
https://www.nxtbook.com/farran/dentaltown/2020February
https://www.nxtbook.com/farran/dentaltown/2020January
https://www.nxtbook.com/farran/dentaltown/2019December
https://www.nxtbook.com/farran/dentaltown/2019November
https://www.nxtbook.com/farran/dentaltownuk/2019OctoberNovember
https://www.nxtbook.com/farran/dentaltown/2019October
https://www.nxtbook.com/farran/dentaltown/2019NewGrad
https://www.nxtbook.com/farran/dentaltown/2019September
https://www.nxtbook.com/farran/dentaltown/2019August
https://www.nxtbook.com/farran/dentaltown/2019July
https://www.nxtbook.com/farran/dentaltownuk/2019JuneJuly
https://www.nxtbook.com/farran/dentaltown/2019June
https://www.nxtbook.com/farran/dentaltown/2019May
https://www.nxtbook.com/farran/dentaltownuk/2019AprilMay
https://www.nxtbook.com/farran/dentaltown/2019April
https://www.nxtbook.com/farran/dentaltown/2019March
https://www.nxtbook.com/farran/dentaltown/2019February
https://www.nxtbook.com/farran/dentaltownuk/2019FebruaryMarch
https://www.nxtbook.com/farran/dentaltown/2019January
https://www.nxtbook.com/farran/dentaltownuk/2018Winter
https://www.nxtbook.com/farran/dentaltown/2018December
https://www.nxtbook.com/farran/dentaltown/2018November
https://www.nxtbook.com/farran/dentaltownuk/2018November
https://www.nxtbook.com/farran/dentaltown/2018October
https://www.nxtbook.com/farran/dentaltownuk/2018October
https://www.nxtbook.com/farran/dentaltown/2018NewGrad
https://www.nxtbook.com/farran/dentaltown/2018September
https://www.nxtbook.com/farran/dentaltownuk/2018September
https://www.nxtbook.com/farran/dentaltown/2018August
https://www.nxtbook.com/farran/dentaltownuk/2018July
https://www.nxtbook.com/farran/dentaltown/2018July
https://www.nxtbook.com/farran/dentaltownuk/2018June
https://www.nxtbook.com/farran/dentaltown/2018June
https://www.nxtbook.com/farran/dentaltownuk/2018May
https://www.nxtbook.com/farran/dentaltown/2018May
https://www.nxtbook.com/farran/dentaltownuk/2018April
https://www.nxtbook.com/farran/dentaltown/2018April
https://www.nxtbook.com/farran/dentaltown/2018March
https://www.nxtbook.com/farran/dentaltownuk/2018March
https://www.nxtbook.com/farran/dentaltown/2018February
https://www.nxtbook.com/farran/dentaltownuk/2018February
https://www.nxtbook.com/farran/dentaltown/2018January
https://www.nxtbook.com/farran/dentaltown/2017December
https://www.nxtbook.com/farran/dentaltownuk/2017Winter
https://www.nxtbook.com/farran/dentaltown/2017November
https://www.nxtbook.com/farran/dentaltown/2017October
https://www.nxtbook.com/farran/dentaltownuk/2017october
https://www.nxtbook.com/farran/dentaltown/NewGrad2017
https://www.nxtbook.com/farran/dentaltown/2017September
https://www.nxtbook.com/farran/dentaltownuk/2017September
https://www.nxtbook.com/farran/dentaltownuk/2017August
https://www.nxtbook.com/farran/dentaltown/2017August
https://www.nxtbook.com/farran/dentaltown/2017July
https://www.nxtbook.com/farran/dentaltownuk/2017July
https://www.nxtbook.com/farran/dentaltown/2017June
https://www.nxtbook.com/farran/dentaltownuk/2017may
https://www.nxtbook.com/farran/dentaltown/2017May
https://www.nxtbook.com/farran/dentaltownuk/2017April
https://www.nxtbook.com/farran/dentaltown/2017April
https://www.nxtbook.com/farran/dentaltown/2017March
https://www.nxtbook.com/farran/dentaltownuk/dentaltownuk/2017march
https://www.nxtbook.com/farran/dentaltown/February2017
https://www.nxtbook.com/farran/dentaltown/2017January
https://www.nxtbook.com/farran/dentaltown/2016December
https://www.nxtbook.com/farran/dentaltown/2016November
https://www.nxtbook.com/farran/dentaltown/2016October
https://www.nxtbook.com/farran/dentaltown/2016nge
https://www.nxtbook.com/farran/dentaltown/2016september
https://www.nxtbook.com/farran/dentaltown/2016august
https://www.nxtbook.com/farran/dentaltown/2016july
https://www.nxtbook.com/farran/dentaltown/2016june
https://www.nxtbook.com/farran/dentaltown/2016may
https://www.nxtbook.com/farran/dentaltown/2016april
https://www.nxtbook.com/farran/dentaltown/2016march
https://www.nxtbook.com/farran/dentaltown/2016february
https://www.nxtbook.com/farran/dentaltown/2016january
https://www.nxtbook.com/farran/dentaltown/2015december
https://www.nxtbook.com/farran/dentaltown/2015november
https://www.nxtbook.com/farran/dentaltown/2015october
https://www.nxtbook.com/farran/dentaltown/2015nge
https://www.nxtbook.com/farran/dentaltown/2015september
https://www.nxtbook.com/farran/dentaltown/2015august
https://www.nxtbook.com/farran/dentaltown/2015july
https://www.nxtbook.com/farran/dentaltown/2015june
https://www.nxtbook.com/farran/dentaltown/2015may
https://www.nxtbook.com/farran/dentaltown/2015april
https://www.nxtbook.com/farran/dentaltown/2015march
https://www.nxtbook.com/farran/dentaltown/2015february
https://www.nxtbook.com/farran/dentaltown/2015january
https://www.nxtbook.com/farran/dentaltown/2014december
https://www.nxtbook.com/farran/dentaltown/2014decemberb
https://www.nxtbook.com/farran/dentaltown/2014november
https://www.nxtbook.com/farran/dentaltown/2014october
https://www.nxtbook.com/farran/dentaltown/2014newgrad
https://www.nxtbook.com/farran/dentaltown/2014september
https://www.nxtbook.com/farran/dentaltown/2014august
https://www.nxtbook.com/farran/dentaltown/2014july
https://www.nxtbook.com/farran/dentaltown/2014june
https://www.nxtbook.com/farran/dentaltown/2014may
https://www.nxtbook.com/farran/dentaltown/2014april
https://www.nxtbook.com/farran/dentaltown/2014march
https://www.nxtbook.com/farran/dentaltown/2014february
https://www.nxtbook.com/farran/dentaltown/2014january
https://www.nxtbook.com/farran/dentaltown/2013december
https://www.nxtbook.com/farran/dentaltown/2013november
https://www.nxtbook.com/farran/dentaltown/2013october
https://www.nxtbook.com/farran/dentaltown/2013newgrad
https://www.nxtbook.com/farran/dentaltown/2013september
https://www.nxtbook.com/farran/dentaltown/2013august
https://www.nxtbook.com/farran/dentaltown/2013july
https://www.nxtbook.com/farran/dentaltown/2013june
https://www.nxtbook.com/farran/dentaltown/2013may
https://www.nxtbook.com/farran/dentaltown/2013april
https://www.nxtbook.com/farran/dentaltown/2013march
https://www.nxtbook.com/farran/dentaltown/2013february
https://www.nxtbook.com/farran/dentaltown/2013january
https://www.nxtbook.com/farran/dentaltown/2012december
https://www.nxtbook.com/farran/dentaltown/2012November
https://www.nxtbookmedia.com