PDF: Management of Oro-antral Communication and Fistula: Various Surgical Options

Oro-antral communication and fistula can occur as a result of inadequate and improper treatment. Inadvertent communication with the maxillary sinus can occur during certain surgical procedures in the maxillary posterior region. 

Though, spontaneous healing may occur in defects which are smaller than 2 mm but larger communications require immediate attention and should be treated without delay, in order to avoid sinusitis and further complications leading to patient discomfort.

Oro-antral communications and fistulas (OACs & OAFs) are complications frequently encountered by oral and maxillofacial surgeons. Oro-antral communication is an unnatural communication between the oral cavity and the maxillary sinus.

These complications occur most commonly during extraction of upper molar and premolar teeth (48%). The major reason is the anatomic proximity or projection of the roots within the maxillary sinus.

In the absence of any infection of maxillary sinus, the defects which are smaller than 2 mm can heal spontaneously following the blood clot formation and secondary healing. 

However, untreated larger defects can lead to development of acute sinus disease like sinusitis (50% of patients within 48 hours, 90% of patients within 2 weeks).

Closure of this communication is very important to prevent any food or saliva accumulation. It can cause sinus contamination leading infection, impaired healing and chronic sinusitis.

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