OAC/OAF Flashcards
What is an OAF?
Epithelialised pathological unnatural communication between mouth and maxillary sinus
-> Forms within 48-72 hours
-> Fails to close spontaneously/surgically
What are the other types of fistulas that can occur?
Oro-cutaneous
Nasal
How does an OAC occur?
- Routine extractions
- Surgical extraction
- Tuberosity fracture- bone distal to 8
- DA/PA infections of molars- erode the bone between apex and sinus
- Implant dislodgment into maxillary sinus- disappear on placement
- Trauma
- Maxillary cysts or tumours- can expand bone and cause erosion of bone
- ORN/MRONJ- dead bone sequestrates off (on removal or spontaneous loss it can result in communication)
- Dehiscence following implant failure
What are the risk factors for an OAC?
- Extraction of teeth 3-8
- Close relationship of roots to sinus on radiographs (difficult to determine on 2D image)
- Last standing molars
- Large/bulbous roots
- Older patient- sinus pneumatisation
- Previous OAC- raises suspicion that roots are close to sinus
- Recurrent sinusitis- undiagnosed dental infection which has breached bone
What are the peri-operative signs of OAC?
Bone at trifurcation of roots comes away (sinus floor segment)
Bubbling at socket
Valsalva test- nose blowing, raises pressure in sinus (can create OAC)
Change in suction sound (echo/resonance)
Direct vision
What are the Post-operative signs of an OAC?
Unilateral discharge (clear/pus)
Fluid from nose when drinking
Salty discharge
Difficulty smoking/drinking through straw
Non-healing socket
Nasal sounding voice
What is an antral polyp?
benign growth in sinus
- Can herniate through socket
How should you consent a patient if there is a risk of an OAC being created?
If roots look close to sinus- tell patient there is a chance of communication being created
Write on form:
Pain, bleeding, bruising, swelling, jaw stiffness, infection, dry socket, OAC, dislodging root in sinus, fractured tuberosity, referral to specialist, further treatment
Say:
“Hole into sinus”- may stretch gum and stitch it to close it, reassure patient you will make relevant arrangements to fix it
If the sinus lining is visible how does it appear?
Shimmering appearance (like cling film)
What do you do for small OAC <2mm?
Pack and monitor, review in week, no nose blowing, no sneeze stifling, CHX, avoid straws, smoking cessation, steam/methol inhalation
- If not healing- Close with BAF (may refer)
- Ephedrine nasal drops 0.5% 1-2 drops 4 times per day for 7 days (keeps sinuses patent)
- Otrivine drops can be used
- AB as for sinusitis- Pen V- 500mg QDS 5 days (only if acute spreading infection- preventive?)
How is an OAC closed?
Full thickness 3 sided BAF- evert flap to expose mucoperiosteum, score this to release it (makes flap much looser and easier to stretch)
-> Closure over communication must be tension free
Alternatively:
-> palatal finger flap, rotated over
-> Buccal fat pad flap- incise buccal mucosa, stretch and suture
What are the potential sequelae if OAC is not closed?
Sinusitis (50% within 48 hours, 90% in 2 weeks)
If patient attends practice with suspected root in antrum, what questions may be helpful to ask?
- Symptoms at time?
- How long did it take?
- Did tooth come out in one piece?
- Was dentist worried about missing roots?
- Was it a surgical?
How is root in antrum managed?
- Through socket (if still open)- raise flap, remove bone, use suction to try and remove root
- Caldwell-Luc- go through sinus wall (incision high up in buccal sulcus- watch patotid duct), use suction and light to help (flush with saline if infected)
- If not infected or carious and small- you can leave it
- Ribbon gauze can help remove- pack and pull out quickly
- Refer to ENT for endoscopic approach if you cannot retrieve
