ByWillie FrancisBOH/BDS IIISMHS, UPNGOROANTRAL COMMUNICATION
OUTLINE• What is Oroantral communication?• What are the causes of oroantral communication?• How is oroantral communication diagnosed in patients?• How do we treat Oroantral communication?• Conclusion – recommendations!
WHAT IS OROANTRAL COMMUNICATION?Oroantral communication is simply described as the unnatural communication between themaxillary sinus and the oral cavity (Doran 2008:2). It is one of the complications which canoccur when doing extraction of the upper molars because sometimes their roots are close tothe maxillary sinus.When this Oroantral communications occur it can cause problems for both the patient and theoperator. Problems such as:• Patient not impressed with the operator• For the operator it is not a practice builder• Possible medico-legal action• Removal of bone that may needed for implants (sinus repair and lift/augmentation may beneeded).• Removal of bony support for dentures
WHY IS OROANTRAL COMMUNICATION APROBLEM?When Oroantral communication is created, it allows food, fluids or smoke from the mouth to flow via the maxillarysinus into the nasal cavityNot only that but also it gives access for bacteria and other microorganisms to travel from the oral cavity into thenose and vice versa.This can set up a maxillary sinusitis, which mainly depends on how long the communication between the oralcavity and the maxillary sinus lasts for, may yield either an acute/chronic maxillary sinusitis (Doran 2008:2).Maxillary sinusitis is a condition that affects the area in which Oroantral communication has occurred.• Oroantral communication has occurred. The following are some of the factors that are caused by maxillarysinusitis:• Sinusitis pain may occur in the cheek, around the eye or in the forward• Pain felt on upper teeth which can be mistaken for a tooth ache• Person to feel malaise with a headache and perhaps a stuffy nose• Discharge of pus into the nose (not noticed until beginning to recover)• Swelling of the face over the sinus• Nasal discharge from back of the nose down to the throat
WHAT ARE THE CAUSES OF OROANTRALCOMMUNICATION?Some of the underlying factors which may contribute to the aetiology of Oroantralcommunications are:• Exodontia• Tumors• Osteomyelitis• Trauma• Dentigerous cysts• Correlation of septal perforations
CONT….However, Oroantral communication is mainly caused by tooth extractions. Studies have shown that out of the2,038 teeth that were extracted perforation occurred in 77 of it (of these 38 teeth were from males & 39 werefrom females) (Doran 2008:2). These perforations occur mostly when an extraction of the upper first molar isdone. Some of the posterior teeth have roots which are long and may grow into the sinus therefor, when theseteeth are being extracted (Doran 2008:2).In the dental clinic there are some surgical procedures that can trigger Oroantral communications. Theseprocedures do not purposely create Oroantral communications but because of the operators mistakes and alsoaccidents that leads to its formation. Some of these are (Doran 2008:2):• Apicectomies of maxillary premolars & molars (perforations occurred in 10.4% of teeth).• Plunging an elevator through the bony floor during root tip removal.• Forcing root tips or tooth into sinus.• Penetration while exposing impacted teeth.• Perforation during incorrect curettage.• Fracture of segment of the alveolar process containing several teeth with tearing of floor of antrum• Luxating an impacted 3rdmolar into the antrum whilst attempting to remove it.
HOW IS OROANTRAL COMMUNICATIONDIAGNOSED?• Diagnosis of acute Oroantral communication – if there is a possibility of Oroantralcommunication then the operator should check the extracted tooth for adherent bone; anadherent bone may stick onto the root of the extracted. Also a nose blowing test must becarried out, if air from the sinus is felt entering the oral cavity then Oroantral cavity issuspected. The size of the defect is determined in order for treatment to begin; if thedefect has a diameter of less than 2mm no treatment is required because itspontaneously heal up (Doran 2008:2).• Diagnosis of chronic – the Oroantral communication is likely to become chronic if thediameter of the connection between the oral cavity and the maxillary sinus is more than5mm, wound dehiscence and enucleation of a cyst. Chronic Oroantral communicationdevelops four to six weeks after an extraction is made. The patient may have problemswith eating, drinking or smoking, will be subject to chronic maxillary sinusitis and alsoexperience purulent discharge from the nose(Doran 2008:2).
HOW DO WE TREAT OROANTRALCOMMUNICATION?Oroantral communication is treated according to its severity. Chronic cases of Oroantral communication aretreated by surgical procedures while acute cases do not need surgery.Treatment of acute Oroantral communication: there is no specific treatment of acute Oroantral communication,however the following can be done;• The defect should not be probed with needles or any other instruments• Promote good blood cloth• The gingival margin around the socket should be approximated as close as possible• Thare has to be some physical agents placed in the socket to stop excessive bleeding, e.g: surgicel,spongostan or haemocollagene• Antibiotics should be prescribed (amoxicillin, doxycycline)• Nasal decongestants can be used (ephedrine nasal drops, oxymetazoline)• Steam inhalation can also be used (menthol and eucalyptus)• Antiseptic mouth-wash can also be used (corsodyl)• The patient is asked not to blow his/her nose and also not to smoke
CONT..Treatment of chronic Oroantral communication: there are two ways which involves surgicalprocedures that can be used for this treatment (Doran 2008:2).1. Buccal advancement flap (most common)• Broad base providing good blood supply.• Periosteum scored parallel to base of flap to allow greater mobilisation of flap.• OAC / OAF mucosa excised.• Alveolus reduced in height.• Palatal mucosa incised & mobilized.• Flap brought across defect & secured with sutures.• There must be no / minimal tension on the flap.• Disadvantage of reduction of buccal vestibular depth; reshapes in 4 -8 weeks as flap adapts tounderlying bone.
CONT…2. Palatal Rotational Advancement Flap (Doran 2008:2).• Advantages of insured vascularity (greater palatine vessels)& thickness of tissue morelike crest of ridge.• OAC / OAF mucosa excised.• Buccal mucosa incised & mobilised.• Flap brought across defect & secured with sutures.• There must be no / minimal tension on the flap.• Allows for the maintenance of the vestibularsulcus depth.• Indicated in cases of unsuccessful buccal flap closure.• Disadvantage of raw surface left behind; can be covered with a plate or Coe-pack.
CONCLUSION - RECOMENDATION• It can be concluded that Oroantral communication is mainly caused by the extraction ofposterior teeth on the maxilla. If not treated the defect may become infected leading toother health problems. Therefore, it is recommended that before any extraction of theupper teeth is done the patient should be assessed carefully. A proper radiograph shouldbe taken to give a proper picture of the position of the teeth and if it is a possible OACthen proper precautions should be taken.
REFERENCE• Doran, J. MD, 2008, Oro-Antral Communication: Aetiology, Diagnosis, Avoidaance &Repair, 2nd edn, East Greenstead, Victoria.