Mouth-Antrum Junction: Surgical Therapy

Dental surgery

• Closure of the MAV by plastic coverage:
  • If the sinus is bland (free of infection), immediately if possible, at the latest within 24 hours
    • Rehrmann’s plasty – trapezoidal mucoperiosteal flap (mucosal and periosteal flap) from the vestibule (oral vestibule).
  • In combination with postoperative decongestant measures and, if necessary, antibiosis (antibiotic therapy).
  • In case of prolonged MAV or symptomatic sinus:
    • Closure only after adequate treatment of infection:
      • If necessary, prolonged irrigation (up to two weeks) over the alveolus until only clear secretion flows back from the nose
      • If necessary, antibiosis

Oral and maxillofacial surgery

• MAV closure techniques:
  • Rehrmann plasty – vestibular trapezoidal flap.
  • Alternative: mobilization of the Bichat fat plug (cheek).
  • Alternative: bridge flap plasty in the area of edentulous alveolar ridge sections.
  • Alternative: palatal (“palatal”) pedicle flap in case of insufficient tissue material for vestibular flap (Rehrmann plasty).
  • Alternatively: pedicled connective tissue graft.
• MAV closure technique for recurrence after Rehrmann plastic surgery:
  • Multi-layer closure, if necessary under intubation anesthesia (ITN).
• Modified maxillary sinus surgery:
  • May be required for chronic MAV.
  • Creation of a bone window to the facial maxillary sinus wall, removal of pathologically altered mucosal areas, and improvement of secretion drainage and ventilation by fenestration to the inferior nasal meatus.