| Closure of Oro-Antral Communications |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
This is a common complication, which may occur during
an attempt to extract the upper back teeth or roots
(premolars & molars).
The mouth-sinus communication (oro-antral
communication) may be confirmed by observing the
passage of air or bubbling of blood from the post-
extraction socket when the patient tries to exhale gently
through their nose while their nostrils are pinched
(Valsalva test). If the patient exhales through their nose
with great pressure, there is a risk of causing oro-antral
communication, even though communication may not
have occurred initially, such as when only the lining
(mucosa) of the maxillary sinus is present between the
tooth socket and the sinus.
Mouth-Sinus communications (oroantral communications)
may be the result of:
an attempt to extract the upper back teeth or roots
(premolars & molars).
The mouth-sinus communication (oro-antral
communication) may be confirmed by observing the
passage of air or bubbling of blood from the post-
extraction socket when the patient tries to exhale gently
through their nose while their nostrils are pinched
(Valsalva test). If the patient exhales through their nose
with great pressure, there is a risk of causing oro-antral
communication, even though communication may not
have occurred initially, such as when only the lining
(mucosa) of the maxillary sinus is present between the
tooth socket and the sinus.
Mouth-Sinus communications (oroantral communications)
may be the result of:
- Displacement of an impacted tooth / root tip into the
sinus (maxillary antrum) during extraction. - Closeness of the root tips to the floor of the sinus
(maxillary antrum). The bony portion above the root
tips is often very thin or may even be absent,
whereupon oro-antral communication is inevitable
during extraction of the tooth, especially if the socket
is 'cleaned' unnecessarily. - The presence of a root-tip infection (peri-apical
lesion) that has eroded the bone wall of the sinus
floor. - Extensive fracture of the maxillary tuberosity,
whereupon part of the maxillary sinus may be
removed together with the maxillary tuberosity. - Extensive bone removal for extraction of an impacted
tooth / root.
Buccal Flaps
- Buccal Advancement Flap most common.
- Described by Rehrmann & made popular by Berger.
Palatal Flaps
- Palatal Rotational Advancement Flap most common
(see diagram below). - Others include Palatal Pedicle Island Flap
(Henderson), - V-shaped Palatal Flap (Krueger) &
- Split-Thickness Palatal Flap (Ito & Hara).
- Nasal decongestants (Ephedrine nasal drops, Oxymetazoline)
- Antiseptic mouth-wash (Corsodyl)
- No nose-blowing or smoking
Alternative Ways to Close an OAC:
- Buccal fat pad
- Laser bio-stimulation (over 5 days)
- Transplantation of a mature wisdom tooth (followed by root canal treatment of
the tooth 5 - 6 weeks later) - Bony block removed from the chin and used to plug the OAC (Autogenous
Mono-cortical Bone Blocks)
Articles:
Acta Stomat Croat 2002. Treatment of Oro-Antral Fistula.
Turk J Med Sc 2004. Buccal Corticotomy for Closure of Oro-Antral Openings -
Case Report.
West Indian Med J 2005. A New Surgical Management for Oro-antral
Communication. The Resorbable Guided Tissue Regeneration Membrane – Bone
Substitute Sandwich Technique.
Med Oral Patol Oral Cir Bucal 2006. Incidence of oral sinus communications in
389 upper 3rd molar extraction.
| Surgical-Dentistry.Info |