Oro antral fistula repair

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an easy guide to various techniques for repair of oro antral fistula

Oro antral fistula repair

  1. 1.  Oro antral communication  Oro antral fistula  Classification:  Alveolo-sinusal  Palatal-sinusal  Vestibulo-sinusal
  2. 2.  Extraction  Maxillary sinus cyst  Tumor  Osteomyelitis  Radiation therapy  Trauma  Syphilis  Implant denture
  3. 3. • Nasal regurgitation of liquid • Unilateral epistaxis • Altered vocal resonance • Bad taste in the mouth • Inability to blow out the cheek • Unilateral malodrous nasal discharge • Delayed symptoms!!!!!
  4. 4.  Ask the patient to pinch his nostrils and blow  Mirror fog test  Cotton wisp test  Passage of fluid from the nose????  Inability to blow mouth
  5. 5.  IOPA  OPG  Water’s view
  6. 6.  Sinus floor discontinuity  Sinus opacity  Focal alveolar atrophy  Associated periodontal disease
  7. 7.  The choice of the appropriate therapy must take into consideration the width, epithelialization and presence or absence of infections.  Defects less than 3mm in width and without epithelialization might heal spontaneously in the absence of infections  Communications wider than 5mm require the use of rotating and sliding flaps to provide closure.
  8. 8.  Immediate surgical repair (preserve the blood clot)  Antibiotics (penicillin with β- lactamase inhibiors)  Local decongestants (methanol or benzoin)  Analgesics Anrtral triage
  9. 9.  White head varnish pack  Denture plate
  10. 10.  Immediate closure  Supportive measures.
  11. 11.  Defer the operation untill the gingival edges of the fistula have healed soundly (approx 3 weeks)  Provisional procedure  Prophylactic treatment
  12. 12.  Re-establish the drainage of maxillary sinus  Supportive medical treatment  When the acute condition has subsided surgical repair of the fistula should be carried out.
  13. 13.  Local flaps  Distant flaps  Bone grafts  Alloplastic materials  Third molar
  14. 14.  Trapezoidal sliding flap- Moczair
  15. 15. Buccal advancement flap- Von rehrmann (1936); Berger (1939)
  16. 16.  Palatal rotational advancement flap- ashley 1939; Kruger modification; Ito et al modification (1980)
  17. 17.  Bridge flap- khazanzian 1949; schudart 1953  Gold foil technique-Crolius 1956, Meyerhoff 1973  Buccal osteoperiosteal flap- Brusati 1982  Third molar (Autotransplantation)
  18. 18.  Tongue flap
  19. 19.  Cladwell luc  Intranasal antrostomy  FESS

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