Oroantral Flashcards
What’s the causes of oroantral communication rather than during extraction ?
- tuberosity fracture
- dentoalveolar/periapical infections of molars
- implant dislodgement into maxillary sinus,
- trauma (7.5%)
5.presence of maxillary cysts or tumors (18.5%) - sometimes as a complication of the Caldwell-Luc procedure.
Teeth under risk in order?
first molar, second molar, second premolar and third molars, first premolar and rarely the canine.
What happen if defect smaller than 2mm or larger ?
absence of any infection of maxillary sinus, the defects which are smaller than 2 mm can heal spontaneously following the blood clot formation and secondary healing.
What should we do if communication more than 2mm ?
In cases with larger oro-antral communications and in patients with history of any sinus disease
surgical closure is indicated.
What’s the complications of large defect ?
development of acute sinusitis (50% of patients within 48 hours, 90% of patients within 2 weeks)
Why closure is so important ?
To prevent any food or saliva accumulation.
It can cause sinus contamination leading infection, impaired healing and chronic sinusitis.
What’s oroantral fistula and how does it develop ?
An oro-antral fistula (OAF) is an epithelialized pathological unnatural communication between oral cavity and maxillary sinus.
It develops when the oro-antral communication fails to close spontaneously, remains patent and gets epithelialized.
There is migration of oral epithelium into the defect
In how much time fistula develop ?
when the perforation persists for at least 48-72 hours.
7-8 days is the average time during which an oro-antral perforation epithelialize and become a chronic fistulous tract
What’s the symptoms of communication ?
nasal regurgitation of liquid
altered nasal resonance
difficulty in sucking through straw
unilateral nasal discharge
bad taste in the mouth and whistling sound while speaking.
Pain may be present at malar region
What’s happen in later stages ?
formation of antral polyp which is visible through the defect intra-orally.
How fistula get diagnosed ?
Clinically, a large fistula is easily seen on inspection.
diagnosis of small defect can be made by the nose blowing test.
The patient is asked to close his nostrils and blow gently down the nose with the mouth open. Presence of OAF appears as a whistling sound as air passes down the fistula into the oral cavity. It can also be seen as air bubbles, blood or mucoid secretion around the orifice.
How do we see in panoramic and CT ?
Panoramic radiograph gives an accurate estimation of the dimension of the bony defect of the fistula and also reveals about the presence and location of dental roots or implants or any foreign body that may have been dislodged into the antrum.
Computed tomography can be done to rule out the presence of maxillary sinusitis.
Which solution we use for irrigation how does performed ?
Preoperatively, the affected maxillary sinus should be irrigated through the fistulous opening with normal saline followed by an
iodine-containing solution diluted with normal saline (1:1; betadine) to eradicate
The most common methods used for closure of OAF ??
buccal flap and the palatal pedicled flap techniques.
What are 2 basic principles that must be considered while operating for OAFs/OACs ?
The first is that the sinus must be free of any type of infection with adequate nasal drainage.
The second is that closure must be tension free and consists of broad based, well vascularized soft tissue flap over the intact bone.
