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Oroantral
Communication
& Fistula
DONE BY: MOSAAB HAWSAWI BDS,
MUSTAFA TASHKANDI BDS,
MOHAMMAD BRASHI BDS,
Outline
 Definition
 Causes
 Signs and Symptoms
 Clinical examination
 Management
 Surgical techniques
Definition
Oroantral communication:
 Abnormal connection between the oral and antral
cavities.
 When oroantral communica...
Causes
 Extraction of maxillary posterior teeth
(most common).
 Tumor.
 Cyst.
 Trauma.
Signs and Symptoms
 Unpleasant tasting discharge and odor.
 Reflux of fluids and foods into the nose
from the mouth.
 L...
Clinical examination
 Inspection after hemostasis.
 Gentle suctioning of the socket produce a
hollow sound.
 Leakage of...
Role of chronic sinusitis
with
 Long-standing fistula may eventually result in
antral infection, due to saliva contaminat...
Patients at high risk:
 Extraction of maxillary 2nd molar
 Periapical infection.
 Approximation of the maxillary sinus ...
Management
Immediate Management:
 The primary purpose is closure of the defect
and prevention of sinusitis through :
 su...
Management
 Communication:
 During endodontic therapy:
- Infected canal  antibiotic , closure and filling
- not infecte...
Management
 During dentoalveolar surgery:
- Small  noninvasive wound closure.
- Large  rotational flaps.
- Extremely la...
Consideration for antibiotic
use
 The use of systemic antibiotic is recommended
as a prophylactic measure:
 Amoxicillin ...
Surgical closure with flap techniques
 Indications:
1. long-standing fistula.
2. failure of an attempted primary closure.
Surgical closure with flap techniques
 Factors that determine surgical technique:
1. whether it is a new communication or...
Surgical closure with flap technique
 Buccal Advancement flap
Technique:
- Indications:
1. Minor communication.
2. Buccal...
Surgical closure with flap technique
 Buccal Advancement
flap Technique:
- Disadvantages:
1. Thin flap  dehiscense.
2. l...
Buccal Advancement flap Technique:
Buccal flap incision
Buccal Advancement flap Technique:
Site sutured after closure
Surgical closure with flap technique
 Palatal flap Technique:
 Advantages:
1. More tissue attachment
without tension.
2....
Surgical closure with flap technique
 Disadvantages:
1. denudation of the palatal
surface.
2. greater post-operative
pain...
Palatal Flap Technique:
Palatal flap incision
Palatal Flap Technique:
Palatal surface exposure
Palatal Flap Technique:
Site sutured after closure Palatal tissue healing
References
 Andrea Enrico Borgonovo, Frederick Valerio Berardinelli, Marco
Favale, Carlo Maiorana. 2012. Surgical Options...
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Oroantral Communication and Fistula

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Transcript of "Oroantral Communication and Fistula"

  1. 1. Oroantral Communication & Fistula DONE BY: MOSAAB HAWSAWI BDS, MUSTAFA TASHKANDI BDS, MOHAMMAD BRASHI BDS,
  2. 2. Outline  Definition  Causes  Signs and Symptoms  Clinical examination  Management  Surgical techniques
  3. 3. Definition Oroantral communication:  Abnormal connection between the oral and antral cavities.  When oroantral communication is left open, epithelial tissue may develop in its track --> "oroantral fistula".
  4. 4. Causes  Extraction of maxillary posterior teeth (most common).  Tumor.  Cyst.  Trauma.
  5. 5. Signs and Symptoms  Unpleasant tasting discharge and odor.  Reflux of fluids and foods into the nose from the mouth.  Leakage of air.  Difficulty in tobacco smoking.  NB. Some patients are asymptomatic.
  6. 6. Clinical examination  Inspection after hemostasis.  Gentle suctioning of the socket produce a hollow sound.  Leakage of air while blowing against closed nostrils.  Radiograph is usually used for confirmation, and to determine extent of the defect.  NB: Probing is generally not recommended , could cause perforation
  7. 7. Role of chronic sinusitis with  Long-standing fistula may eventually result in antral infection, due to saliva contamination.  Duration and width of the communication are the factors that increase the likelihood of sinusitis.  Presence of sinusitis must be ruled out before surgical closure, because presence of infection will prevent healing.
  8. 8. Patients at high risk:  Extraction of maxillary 2nd molar  Periapical infection.  Approximation of the maxillary sinus floor from the teeth apices.
  9. 9. Management Immediate Management:  The primary purpose is closure of the defect and prevention of sinusitis through :  suturing or periodontal pack .  Rinses with physiologic solution.  Rinses with antibiotic solvent.  Antibiotic prophylactic.  N.B. Palatinal plate could be used to attain hemostasis and better sealing.
  10. 10. Management  Communication:  During endodontic therapy: - Infected canal  antibiotic , closure and filling - not infected canal  nothing (low risk of sinusitis). If sinusitis has occured  drainage through the root canal.  During tooth extraction: - Prevention. - < 5mm  noninvasive intervention (spontaneous closure by blood clot). - > 5mm  surgical intervention.
  11. 11. Management  During dentoalveolar surgery: - Small  noninvasive wound closure. - Large  rotational flaps. - Extremely large distant flaps (e.g. tongue flap) & grafts. - Fistula: - Surgical closure is mandatory regardless of the defect size.
  12. 12. Consideration for antibiotic use  The use of systemic antibiotic is recommended as a prophylactic measure:  Amoxicillin 250 mg Q8H for 1-5 days.  Erythromycin 250 mg Q8H for 1-5 days.
  13. 13. Surgical closure with flap techniques  Indications: 1. long-standing fistula. 2. failure of an attempted primary closure.
  14. 14. Surgical closure with flap techniques  Factors that determine surgical technique: 1. whether it is a new communication or fistula. 2. location and size of the defect. 3. anatomical relationship between the defect and the neighboring teeth. 4. height of the alveolar ridge. 5. duration of the sinus exposure. 6. presence or absence of sinusitis. 7. general health status of the patient
  15. 15. Surgical closure with flap technique  Buccal Advancement flap Technique: - Indications: 1. Minor communication. 2. Buccal defect. - Advantages: 1. Simplicity. 2. lower post-operative pain & discomfort. NB: Not preferred for large communication and recurrent fistula
  16. 16. Surgical closure with flap technique  Buccal Advancement flap Technique: - Disadvantages: 1. Thin flap  dehiscense. 2. limited extent. 3. loss of vestibular depth. 4. scaring may cause impaired mobility.
  17. 17. Buccal Advancement flap Technique: Buccal flap incision
  18. 18. Buccal Advancement flap Technique: Site sutured after closure
  19. 19. Surgical closure with flap technique  Palatal flap Technique:  Advantages: 1. More tissue attachment without tension. 2. Firmer and more resistant to trauma and infection. 3. Could be used with large defect. 4. Preserve the buccal vestibular depth.
  20. 20. Surgical closure with flap technique  Disadvantages: 1. denudation of the palatal surface. 2. greater post-operative pain. 3. more complicated technique. 4. appearance of roughness at donor site (epithilization). 5. possible flap necrosis. 6. interfere with wearing partial denture for covering the hard palate.
  21. 21. Palatal Flap Technique: Palatal flap incision
  22. 22. Palatal Flap Technique: Palatal surface exposure
  23. 23. Palatal Flap Technique: Site sutured after closure Palatal tissue healing
  24. 24. References  Andrea Enrico Borgonovo, Frederick Valerio Berardinelli, Marco Favale, Carlo Maiorana. 2012. Surgical Options In Oroantral Fistula Treatment. The Open Dentistry Journal. 2012.  Closure of Oroantral Communications: A Review of the Literature. Susan H. Visscher, Baucke van Minnen, Rudolf R.M. Bos. 2010. 2010, Journal of Oral and Maxillofacial Surgery.  Lars Andersson, Karl-Erik Kahnberg, M. Anthony Pogrel. 2010. Infections. [book auth.] LArs Andersson. Oral and Maxillofacial Surgery. s.l. : Wiley-Blackwill, 2010.  Treatment of Oroantral Fistula. Klara Sokler, Vanja Vuksan, Tomislav Lauc. 2002. 2002, Acta Stomat Croat.

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