Exodontia.Info
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:


  • 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.



  • Extensive bone removal for extraction of an impacted
    tooth / root.
The OAC / OAF is closed using the following flaps:

Buccal Flaps

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).
Post-op Régime



Useful 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.
Last Updated 28th July 2012
Not all possible complications or risks can be foreseen in any medical or surgical
treatment, and this is the case for the closure of
OAC / OAF’s.  There may be
other unusual risks that have not been listed here.  Please ask your Oral Surgeon
if you have any general or specific concerns.


Common Surgical Consequences:

Pain.  As it is a surgical procedure, there will be soreness after the operation.  This
can last for several days.  Painkillers such as
Ibuprofen, Paracetamol, Solpadeine
or Nurofen Plus are very effective.  Obviously, the painkiller you use is dependent
on your medical history & the ease with which the operation was carried out.

Swelling.  There will be swelling afterwards.  This can last up to a week.  Use of
an icepack or a bag of frozen peas pressed against the cheek adjacent to the
operation site will help to lessen the swelling.  Avoidance in the first few hours post-
op, of alcohol, exercise or hot foods / drinks will decrease the degree of swelling
as well.

Bruising.  Some people are prone to bruise.  Older people, people on aspirin or
steroids will also bruise that much more easily.  The bruising can look quite florid;
this will eventually resolve but can take several weeks (in the worst cases).

Stitches.  The operation site will be closed with stitches.  These are dissolve and
‘fall out’ within 10 – 14 days.

Mouth Opening.  Often the chewing muscles and the jaw joints are sore after the
procedure so that mouth opening can be limited for the next few days.  If you are
unlucky enough to develop an infection afterwards in the socket, this can make the
limited mouth opening worse and last for longer (up to a week).

Post-op Infection.  You may develop an infection in the operation site.  This tends
to occur 2 – 4 days later and is characterised by a deep-seated throbbing pain,
bad breath and an unpleasant taste in the mouth.  This infection is more likely to
occur if you are a smoker, are on the
Contraceptive Pill, on drugs such as steroids
and if bone has to be removed to facilitate the closure of the
oro-antral
communication
.  If antibiotics are given, they are likely to react with alcohol and /
or the
Contraceptive Pill (that is, the ‘Pill’ will not be providing protection).

BIPP Pack / Coe-Pack Dressing.  When a palatal flap is used, the bone in the roof
of the mouth can be exposed.  This is sore and can be slow to heal.  With this in
mind, a dressing (
Coe-Pack) or gauze soaked in an antiseptic (BIPP Pack) is sewn
over the bare bone to facilitate healing.  This is removed 7 - 14 days after the op.

Flattening of Vestibulum (Sulcus).  If the tissue used to close the mouth-sinus hole
is drawn from the cheek, then the space between the cheek / lips and the teeth
(
sulcus) is lessened (temporarily).  This tends to slacken off with time but may
necessitate a further op to restore the
sulcus.


Less Common Surgical Consequences:

Bleeding into Cheeks.  Swelling that does not resolve within a few days may be
due to bleeding into the cheek.  The cheek swelling will feel quite firm.  Coupled
with this, there may be limitation to mouth opening and bruising.  Both the swelling,
bruising and mouth opening will resolve with time.

Breakdown of the Flap & Recurrence of the OAC / OAF.  The flap used to close
the mouth-sinus hole can breakdown for a number of reasons.  If this happens,
then, depending on the size of the mouth-sinus hole, the procedure will need to be
done again.