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

3.  Oro antral communication
 Oro antral fistula
 Classification:
 Alveolo-sinusal
 Palatal-sinusal
 Vestibulo-sinusal

4.  Extraction
 Maxillary sinus cyst
 Tumor
 Osteomyelitis
 Radiation therapy
 Trauma
 Syphilis
 Implant denture

5. • 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!!!!!

6.  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

7.  IOPA
 OPG
 Water’s view

8.  Sinus floor discontinuity
 Sinus opacity
 Focal alveolar atrophy
 Associated periodontal
disease

9.  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.

10.  Immediate surgical repair
(preserve the blood clot)
 Antibiotics (penicillin with β-
lactamase inhibiors)
 Local decongestants (methanol
or benzoin)
 Analgesics
Anrtral triage

11.  White head varnish pack
 Denture plate

12.  Immediate closure
 Supportive measures.

13.  Defer the operation untill the gingival edges
of the fistula have healed soundly (approx 3
weeks)
 Provisional procedure
 Prophylactic treatment

14.  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.

15.  Local flaps
 Distant flaps
 Bone grafts
 Alloplastic materials
 Third molar

16.  Trapezoidal sliding flap- Moczair

17. Buccal advancement flap-
Von rehrmann (1936); Berger
(1939)

18.  Palatal rotational advancement flap- ashley
1939; Kruger modification; Ito et al
modification (1980)

20.  Bridge flap- khazanzian 1949; schudart 1953
 Gold foil technique-Crolius 1956, Meyerhoff
1973
 Buccal osteoperiosteal flap- Brusati 1982
 Third molar (Autotransplantation)

21.  Tongue flap

24.  Cladwell luc
 Intranasal antrostomy
 FESS