Closure of oroantral fistula with buccal flap: Rehrmann versus Môczár

A prospective follow-up study of 90 patients with oroantral fistula, persisting for greater than or equal to 10 days, closed with a buccal flap and with systemic penicillin therapy has been carried out. The purpose was: (1) to compare the results after closure with a Rehrmann- and a Môczár-buccal flap; (2) to elucidate the reasons for failures; (3) to clarify when and why a permanent reduction of the vestibular height may occur after the use of buccal flaps. The material was divided into two groups: preoperative preparation (PP) group: 52 cases, closed with Rehrmann (n = 32) and Môczár flap (n = 20). PP included: a rhino-laryngeal examination and an antral irrigation. Follow-up period: 6-12 months. No PP group: 38 Rehrmann flap cases without PP, and followed for 2 months. The analysis shows: (1) the result of closure is independent of the choice of flap; (2) the risk of failure is negligible by careful regimens (elimination of active maxillary sinusitis before/after closure, avoiding sneezing); (3) uneventful repair for 2 months means permanent repair; (4) flattening of vestibulum for 2 months results in a persistent condition; (5) permanent flattening of the vestibulum will occur in about half of the Rehrmann flap cases, independent of the state of dentition or buccal alveolar bone loss; the risk of this complication after a Môczár flap is minimal; (6) scar tissue at the anterior incision of a Môczár flap is a frequent finding; (7) why a Rehrmann flap is the treatment of choice for patients with natural teeth and a Môczár flap for edentulous patients.