This document discusses oroantral communications and fistulas. It defines them as abnormal connections between the oral and maxillary sinus cavities. Causes include tooth extraction, tumors, cysts, and trauma. Signs and symptoms may include unpleasant taste/odor, fluid/food reflux into the nose, and air leakage. Examination involves inspection, suctioning the socket, and radiographs. Management includes immediate closure attempts and antibiotics to prevent sinusitis. Surgical techniques like buccal and palatal flaps are used for larger defects or fistulas based on factors like location, size, and presence of infection.

1. Oroantral
Communication
& Fistula
DONE BY: MOSAAB HAWSAWI BDS,
MUSTAFA TASHKANDI BDS,
MOHAMMAD BRASHI BDS,

2. Outline
 Definition
 Causes
 Signs and Symptoms
 Clinical examination
 Management
 Surgical techniques

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. Causes
 Extraction of maxillary posterior teeth
(most common).
 Tumor.
 Cyst.
 Trauma.

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. 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. 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. Patients at high risk:
 Extraction of maxillary 2nd molar
 Periapical infection.
 Approximation of the maxillary sinus floor
from the teeth apices.

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. 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. 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. 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. Surgical closure with flap techniques
 Indications:
1. long-standing fistula.
2. failure of an attempted primary closure.

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. 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. 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. Buccal Advancement flap Technique:
Buccal flap incision

18. Buccal Advancement flap Technique:
Site sutured after closure

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. 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. Palatal Flap Technique:
Palatal flap incision

22. Palatal Flap Technique:
Palatal surface exposure

23. Palatal Flap Technique:
Site sutured after closure Palatal tissue healing

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.