Maxillary sinus perforations and closures

The management of various types of oroantral perforation has been discussed in detail. Oroantral perforation often occurs in spite of adequate precautions in the surgical extraction of a tooth opening into the floor of the sinus. Failure to heal is generally due to infection or to a drain, plug, or gauze pack that has been inserted in the extraction wound after the perforation during removal of a root or during curettage. Plastic closure following such an accident may not be successful, either for technical reasons or because the sinus becomes infected. An alveolar opening often can be repaired by direct transposition of a fullthickness pedicle palatal flap. With this single-stage operation, a fistula may be adequately closed even though several attempts have been made with other techniques.