Definitions

Oroantral communication: An opening between the oral cavity and the maxillary

sinus.

Oroantral fistula: An opening between the oral cavity and the maxillary

sinus, were both epithelia (antral and oral mucosa) heal together.

Causes

• Postoperative fistulas in the oronasal and oroantral regions generally result from soft tissue injury at the time of surgery.

• This may occur as a result of rotary instruments, saws, accidental pushing of remaining roots, clumsy extraction of a tooth with roots lying close or in contact with the sinus membrane, or osteotomies that perforate the palatal mucosa at the time the segmental osteotomies are completed.

• Necrosis of the soft tissue as a result of tearing, stretching or impingement results in a fistula.

• Careful soft tissue manipulation at the time of surgery in an attempt to prevent tissue perforation is the best method for prevention of fistula formation.

Detection of Oroantral Communication

• To detect an oroantral communication when suspected after an extraction, we use the Valsalva maneuver, which is done by closing the patients nose and asking him/her to try exhaling against the pressure of our fingers.

if there was a communication, w can see and hear the sound of air bubbles coming out of the extraction area.

Open Communication

After Closue

Instructions

• In all cases of oroantral communications, the patient should be advised to take antibiotics, decongestants, avoid smoking, sneezing, blowing the nose, spitting….

Management

Management of the communications depending on the size.

A communication less than 5mm in diameter, in the abcense of sinus disease, the defect tends to close spontaneously. (((a suture of the socket)))

A communication larger than 5mm need intervention, either surgical or non-surgical.

Management (non-surgical)

• Using obturators– Obturators should not place pressure on the palatal

mucosa to allow optimum vascularization to the healing wound.

Management (surgical)

Local flaps (e.g., palatal rotational advancement and buccal advancement flaps).

Distant flaps (e.g., tongue flaps) Grafts (e.g., bone).

Large Oroantral Communications

When a large communication is noted postoperatively, several measures can be pursued that may allow the fistula to close spontaneously:

1.Preventing sinus or nasal infections is essential. This includes antibiotic therapy, decongestants, and nasal drainage.

2.Construction of an appliance that will obturate the opening without placing pressure on the overlying tissue will generally help in closure by reducing food contamination

3. If local measures, appropriate medical therapy, and fistula obturation have been unsuccessful, surgical closure of the fistula will be required.

1. Rotational flaps2. Buccal fat pad flaps3. Tongue flaps

Fistula Treatment

• If a fistula is formed, the lining epithelium of the sinus heals with the oral mucosa. Other measures should be performed.

• It is important that the epithelial lining of the fistula is removed, in order to guide the new healing process, either by suturing the epithelia separately, or by using membranes to prevent a fistula from recurring during the healing process.