An oro-antral fistula is an abnormal communication between the oral cavity and maxillary sinus. It is commonly caused by tooth extractions or trauma to the face. Symptoms include escape of fluids or air from the sinus, pain, and discharge. Diagnosis involves tests like blowing the nose to feel air escape from the mouth. Treatment first requires eliminating any sinus infection, then surgically excising the fistula tract and closing the bony defect, often using local soft tissue flaps or bone grafts. The buccal advancement flap and palatal transpositional flap are commonly used procedures.

1. Definition: Oro-antral fistulais an epithelized, pathological, unnatural communication between the oral
cavity and maxillary sinus.
Causes Signs & Symptoms Diagnostic Test
 Injudicious use of the
elevators
 Extraction of upper teeth
 Malignant tumors
 Extensive trauma to face.
1.Escape of fluids & epistaxis.
2.Escape of air during sucking, smoking
3.Excruciating pain & popping out of
polyp & systemic toxicity (fever,malaise)
4.Persistent mucopurulent discharge.
 Nose blowing test
 Mirror fog test
 Cotton wisp test
 Radiographs :
1. Water’s View 2.OPG
Buccal Advancement Flap
(von Rehrmann 1936)
Palatal Transpositional
Flap ( Ashley 1939)
1. Buccal Pad of Fat
A larger buccal flap is taken
after excising the fistula. A
pedicled portion of the
buccal fat pad is gently
placed over the defect and
sutured with a round body
needle.
Advantage: Shows good
rate of epithelization & low
failure rate.
Disadvantage: Chances
of traumatising the pterygo
maxillary space
2. Temporalis Muscle Flap
3. Nasolabial Flap
4. Temporo-parietal
Galeal Flap
Indication:
Most commonly used flap
for closure of OAF.The
flap is elevated & the
periosteum is released &
the flap is extended over
the defect and sutured.
Disadvantage:
Reduction in depth of the
sulcus of vestibule.
Combined Buccal &
Palatal Flaps
Step 1
Step 2
Step 3
Indications:
• Used when buccal
advancement flap failed
• When the OAF is situa-
etd palatally.
Advantages:
• Very thick, strong & well
vascularised.
• Does not affect vestibu-
lar depth
Disadvantages:
1. Large area of exposed
bone takes a long time to
heal 2. Flap shrink on
elevation 3. GP artery
may be damaged
The greater palatine artery is
dissected from the flap which
is excised and then sutured
over the bony defect
Indications:
1.It is used for closure of
palatal defects formed after
surgical excision of tumors
2.very posteriorly situated
OAF.
Also a Distant Flap
Mainly of two types:
1.Anteriorly based tongue flap
2.Posteriorly based tongue
flap
Local Soft Tissue Flaps Distant Flaps
Palatal Island Flap
Step 1: We have to eliminate
any acute/chronic sinus infection
before surgical closure of OAF.
This can be done by:
• Antral lavage (Normal saline)
• Antibiotics (Amoxycillin)
• Nasal Decongestants (0.5%
Ephedrine nasal drops)
• Antihistamines
• Analgesics (Ibuprofen
400mg)
• Construct a acrylic denture
plate to prevent food entry.
If disease persists we have to go
for Caldwell-Luc procedure.
Step 2: After elimination of the
sinus infection we can excise the
chronic fistulous tract
 Adequate local anesthesia is
given by local infiltration
 Fistulous tract is excised with
a 3-4mm margin, sutured
together if possible, &
inverted into the sinus cavity
Step 3: Now we can close the
bony defect by Flap elevation or
by using Free Grafts
Autogenous Bone Grafts
used for closure of OAF:
1.Iliac Crest 2.Ribs
3.Cancellous bone from mandible
Management
Dibya Falgoon Sarkar, Roll No. 24 (NBDC&H)
Bone Grafts
Tongue Flap