detailed covered , involving surgical procedures

1. OROANTRAL
COMMUNICATION
SUMITA
HOUSE OFFICER

2. OROANTRAL
COMMUNICATION:
Communication between the maxillary
sinus and oral cavity . It is one of the
complication which can occur when
doing extraction of upper molars .

3. ETIOLOGY:
1. Extraction of maxillary posterior teeth
2. Roots of tooth are widely divergent

4. 3.Maxillary molar roots in close proximity
to maxillary sinus

5. 4.Destruction of portion of sinus floor by
periapical lesion

6. 5.Perforation of sinus floor and sinus
membrane with injurious use of
instruments
6.Little or no bone between maxillary sinus
and tooth
7.Fracture of maxillary tuberosity

7. SIGN AND SYMPTOMS
1. Unpleasant tasting discharge and odor
2. Reflux of fluids and food into nose from the
mouth
3. Leakage of air
PATIENTS AT HIGH RISK
1. Extraction of maxillary 2nd molar
2. Periapical infection
3. Approximation of the maxillary sinus floor
from teeth apices

8. DIAGNOSIS:
1. Examine the tooth once it is removed , if a
section of bone is attached with root ends ,
surgeon should assume that communication
is present
2. Nose blowing test:
this test involves pinches the
nostrils together to occlude the patient’s nose
and asking the patient to blow gently through
the nose ,while the surgeon observes the
area of tooth extraction .
If communication exist , there will be passage of
air through the tooth socket and bubbling of
blood in the socket.

9. 3. take radiograph
4.After diagnosis see the size of communication

10. PREVENTION

11. MANAGEMENT
The best treatment can be achieved
through:
1.Careful observation
2.Radiographs
3. Do not probe the defect
4.Promote good blood clot
5.Place suture

12. Management depends upon
size of opening
1. If the communication is small (2mm in
diameter or less) – no surgical
treatment is necessary
 The surgeon should take measures to
ensure the formation of high quality
blood clot in the socket and advise to
take sinus precautions to prevent
dislodgement of the blood clot.

14. 2. If opening between mouth and sinus is of
moderate size (2-6mm)
 ensure the maintenance of the blood clot in the
area
• figure of eight suture should be placed over the
socket
• Advise sinus precautions
• Antibiotics usually amoxicillin
or clindamycin –prescribed for
5 days
• A decongestant nasal spray
-prescribed to shrink the nasal
Mucosa.
Maintain follow up

15. 3. If the sinus opening is large ( 7mm or larger)
 the surgeon should consider having the sinus
communication repaired with a flap procedure
 The most commonly used flap for small opening
is the buccal flap

16. PROCEDURE:
1. elevate the buccal flap , base should be broad with adequate
width to cover the communication
2. flap must be free of tension
3.repositiong of the flap across the extraction site
4.flap sutured in
position
BUCCAL FLAP

17. COMPLICATION
1.Postoperative maxillary sinusitis
2.Formation of chronic oroantral fistula

18. POSTOPERATIVVE
MAXILLARY SINUSITIS:
 When an Oroantral communiaction is
created, this allows the flow of food,
smoke or fluid from the mouth, via the
maxillary sinus and into the nose.
 Not just these but also bacteria, fungi
and viruses. This can set up a maxillary
sinusitis, which depending on how long
the communication lasts for, may either
yield an acute/chronic maxillary sinusitis.

19.  Maxillary Sinusitis (1):
 Sinusitis pain may occur in the cheek,
around the eye or in the forehead.
 Sometimes the pain may be felt in the
upper teeth and mistaken for toothache.
 Feel malaise, with a headache and
perhaps a stuffy nose.
 Discharge of pus into the nose is not
noticed until beginning to recover.

20.  Maxillary Sinusitis (2):
 Swelling of the face over the sinus
sometimes occurs but is not usually
marked.
 Some patients have repeated infections
and go on to develop chronic sinusitis.
 Nasal discharge from the back of the nose
down the throat may occur.
 Often the condition will flare up, with acute
pain.

21. OROANTRAL FISTULA
Oroantral fistula is characterized by formation of
epithelized tract between maxillary sinus and oral
cavity
 When chronic
Oroantral fistula
Defects are wider
Than 5mm and persist
For more than 3 weeks
A secondary surgical
Intervention is required
-buccal flap
-palatal flap

22. TREATMENT
 Before closure of oroantral fistula, it is
imperative to eliminate any acute or
chronic infection within the sinus.
 This may require frequent irrigation of
the fistula and sinus combined with the
use of antibiotics and decongestants .

23. BUCCAL FLAP
PROCEDURE
1. Buccal flap has been elevated
2. The epithelium lining the fistula has
been excised , the periosteum is
released
3. Tension free flap has been closed
across the defect .
4. Suture placed

26. BUCCAL PEDICLE FAT
FLAP
 Pedicled buccal fat pad flaps have been
recommended for the closure of fistulas and
communications.
 Among the advantages of this technique are
the low morbidity rate, maintenance of the
vestibular sulcus depth, the low incidence of
failure, and the good flap vascularization .
 when fat tissue is exposed to the oral
environment, it becomes epithelialized and is
gradually replaced by fibrous conjunctive
tissue within a 30-40-day postoperative period,
without any functional damage to the treated
site.

27. A larger buccal flap is elevated and
defect is covered by pedicled
portion of the buccal fat pad with
closure of mucoperiosteal flap
Case of oroantral communication
closure using a pedicled buccal
fat pad graft.
(A) Late bucco-sinusal fistula in the
15-16 tooth area.
(B) Circular incision around the
fistula and mucosa displacement
on the fistulous path.
(C) Absorbable 4-0 catgut suture on
the right maxillary sinus mucosa.
(D) Buccal fat pad dragging into the
fistula site.
(E) 4-0 silk suture in isolated places
around the fat tissue.
(F) Tissue repair in the 30-day
postoperative follow-up.

28. PALATAL FLAP
 Palatal flap is often used to close n oroantral
fistula
PROCEDURE:
1.Soft tissue surrounding the oroantral opening is
excised, exposing underlying alveolar bone
around the osseous defect
2.The full thickness palatal
flap is outlined and elevated

30. 3.Advantages of insured vascularity (greater
palatine vessels)& thickness of tissue more
like crest of ridge.
4.Allows for the maintenance of the
vestibularsulcus depth.
5. Flap is rotated to ensure that there is no
tension on the flap when positioned to cover
the osseous defect
6. Flap rotation and closure
7.Suture placed
8.Follow up
9.Indicated in cases of unsuccessful buccal
flap closure

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