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

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. 

Other causes of OAC/OAF include tuberosity fracture, dentoalveolar/periapical infections of molars, implant dislodgement into maxillary sinus, trauma (7.5%), presence of maxillary cysts or tumors (18.5%), osteoradionecrosis, flap necrosis, dehiscence following implant failure and sometimes as a complication of the Caldwell-Luc procedure.

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.

Wassmund reported development of sinusitis in 60% of cases by fourth day after sinus exposure while Eneroth and Martensson reported a sinusitis rate of 50% by the third day after OACs occured. 

Therefore, a confirmatory and early diagnosis of OACs is mandatory to permit successful closure. Also, management of oro-antral communication to promote closure should be done within 24 hours. 

In cases with larger oro-antral communications and in patients with history of any sinus disease, surgical closure is indicated.  

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