By Supattra Thairungrot

OAC (Oroantral communication)

: An abnormal connection between the oral cavity and the maxillary sinus

OAF (Oroantral fistula)

: An epithelial – lined tract that forms after OAC

Maxillary sinus

-Pneumatization -Grow laterally from medial -Stop by the age 15 -Average volume of adult maxillary sinus is about 15 ml.

1. Ostium : the way to connect the nasal cavity -the way to secrete the secretion -clean the mucous membrane

2. Epithelium line : -Pseudostratified columnar ciliated epithelium -cilia sweep the secretion and foreign body to ostuim

3. Quality and Quantity If three factors are imbalance, it will have the chance for infection.

Cause of OAC

•Dental extraction •Facial trauma •Preprosthetic surgery

Cause of OAC (cont.)

•Osteomyelitis or ORN of maxillary alveolar ridge •Neoplasm

Sign & Symptom of OAC

•Nasal regurgitation of liquid •Altered nasal resonance •Cannot suck through straw or cigarette

Sign & Symptom of OAC (cont.)

•Unilateral nasal discharge •Bad taste in the mouth

Oral Examination

# Be careful # Mouth mirror # Bleeding may obscure visibility

Technique : Ask the patient to attempt to blow the nose whilst pinching the nostrils

Results : •Normal : Nothing •OAC :-Bubbles of blood or saliva -a small piece of cotton wool under the OAC, cotton wool can move.

Precaution

!!!!!

Probing

- Can transfer fluid through the OAC into maxillary sinus. Also transfer oral flora or pushing contaminated bone fracture or bone fragments

Probing (cont.) - May breach an intact maxillary floor or mucosal lining - May increase the size of an existing OAC, lessen the chances of spontaneous closure and complication

Irrigation

- Can transfer fluid through the OAC into maxillary sinus.

Irrigation (cont.)

Also transfer oral flora or pushing contaminated bone fracture or bone fragments.

Radiographs

•Use for confirm diagnosis •To assess the size of the OAC •May not be demonstrate if it is a small defect

1.Water’s view

Useful for maxillary sinuses and to compare for the internal opacity

2. Panoramic (OPG)

Show both maxillary and internal structure and part of inferior wall, posterior wall, and antero - posterior wall

3. Periapical technique

floor of the maxillary sinus

Treatment

Principle : “If the OAC is happen, should be close immediately for prevent saliva and oral flora get through.”

Immediate treatment Further option for the treatment

Immediate treatment

- Protect the blood clot - Acrylic base plate/ ribbon gauze

•If there is sufficient soft tissue -suture opposing palate and buccal mucosa -suture retain for 10-14 days -reducing the height of the bony socket edge with bur

• If there is insufficient soft tissue or fail

Further option for the treatment

Further options for the treatment

Use tissue from local flaps and some distant flaps, such as from the tongue and buccal fat pad, to close OAC

No infection and inflammation

Local flap

Buccal flap

- A sharp probe is used to locate the edge of the bone -Excise soft tissue margin leaving 2-3 mm. rim

Buccal flap (cont.) -Vertical incision with a board base on buccal mucoperiosteal flap -The periosteum lining the inner surface of the flap is cut parallel to and close to its base, allowing the flap to be stretch

Buccal flap (cont.) -The palatal margin is slightly undermined and the wound close with mattress sutures.

Advantage - Broad base providing good blood supply -No raw surface left behind - No rotation Disadvantage -Reduction of buccal vestibule

Palatal flap

-Excise an elongated mucoperiosteal palatal flap, which follow the course of the greater palatine artery. It should be for long enough for its free end to be rotated to cover the defect.

Palatal flap (cont.) -Care of the greater palatine artery not to cut or damage it -The flap is sutured across the defect using mattress sutures

Advantage -Good blood supply -Thickness of tissue more like crest of ridge Disadvantage -Raw surface left behind and rotation

Medication

• Antibiotics - Amoxicillin • Antihistamine and decongestants - Actifed

Postoperative care

• Avoid nose blowing.

• Keep the wound clean with warm saline mouthwash and brushing adjacent area with a toothbrush.

Special Thanks

Kathawut Tachasuttirut