OAC

Question 1

OAC def

Answer 1

Pathological unnatural communication between oral cavity and maxillary sinus

Question 2

OAF def

Answer 2

Epithelialised pathological unnatural communication between oral cavity and maxillary sinus
When OAC fails to close, remains patent and becomes epihtelialsed
Becomes epitheliaslised when perforation persists for min 48-72hrs

Question 3

How can OAC occur?

Answer 3

Routine forceps extraction
Surgical extraction
Tuberosity fracture
Maxillary cysts or tumours

Question 4

Risk factors of OAC

Answer 4

XLA of upper molars or premolars
XLA last standing tooth
Large bulbous roots
Close relationship of roots to max sinus radiographically
Prev OAC
Recurrent sinusitis

Question 5

Give the Pre op Peri op and Post op signs of OAC

Answer 5

Pre op
- Size of tooth and radiographic pos of roots in relation to antrum

Peri op
- Bubbling of blood in socket
- Bone removed at trifurcation
- Valsalva test
- Change in suction sound
- Direct vision

Post op
- Unilateral discharge
- Salty discharge
- Fluid from nose when drinking
- Difficulty smoking / drinking through straw
- Non healing socket

Question 6

Intra oral appearance of OAC

Answer 6

OAC following xla
OAF with epihtelialised tract
Antral polyp

Question 7

Management of OAC

Answer 7

1. Inform and gain consent to monitor, close or refer
2. If small <2mm , monitor and allow to heal spontanesouly
3. If large close with buccal advancement flap or refer
4. Conservation advice
   
   • No nose blowing
   • Do not stifle a sneeze
   • Don’t agitate the area
   • 0.2% CHX or WSMR
   • Avoid straws
   • Smoking cessation
   • Steam inhalations with menthol crystals
5. Consider prescription for nasal decongestants
   
   • ephedrine nasal drops 0.5 % 10ml 1-2 drops up to 4 times a day as required for max 7 days
6. AB - PenV 250mg 2 tablets 4/5

Question 8

What can occur after OAC - if not closed?

Answer 8

1. Sinusitis
2. Food/saliva accumulation in sinus
3. Infection
4. Impaired healing

Question 9

Management of dislodged root into sinus

Answer 9

1. Confirm with PA +/- OPT
2. If small consider monitoring but advise of infection risk
3. If large consider refer or buccal advancement flap
4. Copious amounts of saline with suction and try to retrieve root
5. May need to widen socket with saline cooled bur to increase chance of retrieval
6. Ribbon gauze
7. Consider endoscopic of Caldwell luc technique