Osteo-odonto-keratoprosthesis on oro-antral fistula (OAF), as that

(OOKP) is the procedure of choice for restoring sight in patients with
end-stage ocular disease, where cornea transplantation will not be a success. This
technique is especially resilient against hostile environment such as
keratinized eye resulting from severe chemical injury, Steven-Johnson syndrome,
trachoma, ocular cicatricial pemphigoid, Erythema multiforme, vascular corneal
surgeries, or patients who had previous failed cornea transplantation.(1)

Complications of
OOKP surgery may include oral, ocular and systemic complications. The oral
complications include caries, oroantral fistula, oro-nasal fistula, lip paresthesia,
and sub mucosal scar bands(2). We here are focusing on oro-antral fistula
(OAF), as that pertains to our case. The oroantral fistula is a pathological communication
between the oral cavity and the maxillary sinus. These kind of communications
arise mainly after extraction of posterior maxillary teeth due to the close
anatomical relationship between the roots of the molar and premolar teeth and
the sinus floor, which are separated by a thin bony lamella.(4) Tooth extraction was the most common
etiologic factor, and malignancy should excluded in all patients 48% (3).

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The complication
of an oroantral fistula can be prevented by applying a sound surgical technique
and taking certain precautions. The selected tooth is harvested along with the
alveolar bone surrounding it, with its associated mucoperiosteum. An incision
is made to the bone, which is sectioned on either side of the bone and
mucoperiosteum elevated from adjacent teeth. The bone cuts are made between the
teeth and below the chosen tooth with a fine saw, under constant irrigation to
minimize any thermal injury to the lamina. Mucosal flap from the adjacent area
can be used to cover the resulting alveolar defect, even though the exposed
bone epithelializes very rapidly. (5)