Oroantral communication is an unnatural connection between the maxillary sinus and oral cavity, usually caused by extraction of upper molars whose roots are near the sinus. It allows food and bacteria to pass between the mouth and sinus, risking sinusitis. Diagnosis involves checking extracted teeth for bone fragments and testing for air flow into the mouth from the sinus. Small communications under 2mm often heal spontaneously with antibiotics and nasal decongestants, while larger chronic cases require surgical closure like a buccal or palatal flap to seal the defect. Proper assessment and radiographs before extractions can help prevent oroantral communications.

1. By
Willie Francis
BOH/BDS III
SMHS, UPNG
OROANTRAL COMMUNICATION

2. 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!

3. WHAT IS OROANTRAL COMMUNICATION?
Oroantral communication is simply described as the unnatural communication between the
maxillary sinus and the oral cavity (Doran 2008:2). It is one of the complications which can
occur when doing extraction of the upper molars because sometimes their roots are close to
the maxillary sinus.
When this Oroantral communications occur it can cause problems for both the patient and the
operator. 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 be
needed).
• Removal of bony support for dentures

5. WHY IS OROANTRAL COMMUNICATION A
PROBLEM?
When Oroantral communication is created, it allows food, fluids or smoke from the mouth to flow via the maxillary
sinus into the nasal cavity
Not only that but also it gives access for bacteria and other microorganisms to travel from the oral cavity into the
nose and vice versa.
This can set up a maxillary sinusitis, which mainly depends on how long the communication between the oral
cavity 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 maxillary
sinusitis:
• 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

6. WHAT ARE THE CAUSES OF OROANTRAL
COMMUNICATION?
Some of the underlying factors which may contribute to the aetiology of Oroantral
communications are:
• Exodontia
• Tumors
• Osteomyelitis
• Trauma
• Dentigerous cysts
• Correlation of septal perforations

7. CONT….
However, Oroantral communication is mainly caused by tooth extractions. Studies have shown that out of the
2,038 teeth that were extracted perforation occurred in 77 of it (of these 38 teeth were from males & 39 were
from females) (Doran 2008:2). These perforations occur mostly when an extraction of the upper first molar is
done. Some of the posterior teeth have roots which are long and may grow into the sinus therefor, when these
teeth are being extracted (Doran 2008:2).
In the dental clinic there are some surgical procedures that can trigger Oroantral communications. These
procedures do not purposely create Oroantral communications but because of the operators mistakes and also
accidents 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.

8. HOW IS OROANTRAL COMMUNICATION
DIAGNOSED?
• Diagnosis of acute Oroantral communication – if there is a possibility of Oroantral
communication then the operator should check the extracted tooth for adherent bone; an
adherent bone may stick onto the root of the extracted. Also a nose blowing test must be
carried out, if air from the sinus is felt entering the oral cavity then Oroantral cavity is
suspected. The size of the defect is determined in order for treatment to begin; if the
defect has a diameter of less than 2mm no treatment is required because it
spontaneously heal up (Doran 2008:2).
• Diagnosis of chronic – the Oroantral communication is likely to become chronic if the
diameter of the connection between the oral cavity and the maxillary sinus is more than
5mm, wound dehiscence and enucleation of a cyst. Chronic Oroantral communication
develops four to six weeks after an extraction is made. The patient may have problems
with eating, drinking or smoking, will be subject to chronic maxillary sinusitis and also
experience purulent discharge from the nose(Doran 2008:2).

9. HOW DO WE TREAT OROANTRAL
COMMUNICATION?
Oroantral communication is treated according to its severity. Chronic cases of Oroantral communication are
treated 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

10. CONT..
Treatment of chronic Oroantral communication: there are two ways which involves surgical
procedures 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 to
underlying bone.

13. CONT…
2. Palatal Rotational Advancement Flap (Doran 2008:2).
• Advantages of insured vascularity (greater palatine vessels)& thickness of tissue more
like 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.

15. CONCLUSION - RECOMENDATION
• It can be concluded that Oroantral communication is mainly caused by the extraction of
posterior teeth on the maxilla. If not treated the defect may become infected leading to
other health problems. Therefore, it is recommended that before any extraction of the
upper teeth is done the patient should be assessed carefully. A proper radiograph should
be taken to give a proper picture of the position of the teeth and if it is a possible OAC
then proper precautions should be taken.

16. REFERENCE
• Doran, J. MD, 2008, Oro-Antral Communication: Aetiology, Diagnosis, Avoidaance &
Repair, 2nd edn, East Greenstead, Victoria.