Exodontia.Info
Mouth-Sinus Holes
(
Oro-Antral Communications)
What is an Oro-Antral Communication (OAC)?

This is a communication between the maxillary sinus /
antrum and the oral cavity / mouth.

What is an Oro-Antral Fistula?

If an OAC is not treated, this can become lined with
epithelium (skin).  Hence, an oro-antral fistula is an
epithelised tract linking the maxillary sinus to the mouth;
the tract becomes 'permanent'.

(Alternative names for an OAC / OAF include
oro-antral
fistulæ & oral fistulæ
, sinus perforations and antra-oral
fistulæ
).
Photos of Oro-Antral Communications
CT Scan Showing Oro-Antral Fistula
When an OAC is created, it allows the flow of food, smoke or fluid from the mouth
into the nose - not just these but also bacteria, fungi and viruses.  This can set up a
maxillary sinusitis, which depending on how long the communication lasts for, may
either yield an
acute / chronic maxillary sinusitis.


Causes of OAC’s:

The vast majority of
OAC's are created when upper molars and premolars are
removed
(almost 50%),  tumours (18.5%), bone infections (osteomyelitis) (11%),
operations to access the maxillary sinus (
Caldwell-Luc procedures) (7.5%), trauma
(7.5%),
dentigerous cysts (3.7%), correction of septal perforations (3.7%),
perforation of the sinus floor from the tooth socket when trying to remove an upper
tooth and localised florid gum disease (
HIV-related periodontitis) or tooth-tip
infections (
chronic apical infection).


Predictive Factors:

As a very broad generalisation, the following may be thought to predispose to an
OAC being formed:

  • Proximity of sinus floor / tuberosity
  • Thickened tooth cement (hypercementosis) / tooth fused to jaw bone
    (ankylosis)
  • Infected teeth / long-standing decay
  • Marked periodontitis / gum disease
  • Lone-standing
  • Previous history of OAC’s.


Treatment of the Acute OAC:

If an
OAC has been created, then:

  • Do not probe the defect
  • Promote good blood clot
  • The gingival / gum margins around the socket should be approximated as
    close as possible
  • Physical agents placed in the socket to stop excess bleeding (Surgicel,
    Spongostan or Haemocollagene)
  • Antibiotics should be prescribed (Amoxycillin, Doxycycline)
  • Nasal decongestants can be used (Ephedrine nasal drops, Oxymetazoline)
  • Steam inhalations can be used (Menthol & Eucalyptus)
  • Antiseptic mouth-wash should be used (Corsodyl)
  • No nose-blowing or smoking


How to Recognise the Chronic OAC / OAF:

The
OAC is likely to become chronic if:

  • OAC is greater than 5mm in diameter
  • Gingival tissues / gums around the socket can’t be approximated
  • Post-op régime is not followed
  • Wound dehiscence / breakdown
  • Enucleation of a dental / dentigerous cyst
  • May develop 4 – 6 weeks post-extraction
  • Problems with smoking, eating or drinking
  • Cacogeusia / foul taste
  • Chronic maxillary sinusitis
  • Antral polyp herniating into the mouth
  • Purulent (pus) discharge from nose


Treatment of the Chronic / Larger OAC / OAF:

  • The OAC is assessed with X-rays & CT's.
  • The OAC may still spontaneously close if a cover plate used.
  • If the OAC / OAF needs closing, pre-op antibiotic & decongestant régime
    (starting 3 – 7 days pre-op).


The OAF is closed using the following flaps:

Buccal Flaps

Buccal Advancement Flap most common.  Described by Rehrmann & made
popular by
Berger.

Palatal Flaps



Post-op Régime:

  • Antibiotics (Amoxycillin, Doxycycline)
  • Analgesics
  • Nasal decongestants (Ephedrine nasal drops, Oxymetazoline)
  • Steam inhalations (Menthol & Eucalyptus)
  • Antiseptic mouth-wash (Corsodyl)
  • No nose-blowing or smoking
Last Updated 15th December 2014
Useful Articles:

BJOMS 1986.  Oro-Antral Fistulae - A Study of Clinical, Radiological & Treatment
Aspects

Acta Stomat Croat 2002.  Treatment of Oro-Antral Fistula

Austral Dent J 2003.  Non-Surgical Management of an Oro-Antral Fistula in a
Patient with HIV Infection

Dental Update 2004.  The Buccal Fat Pad in the Closure of Oro-Antral
Communications: An Illustrated Guide

Turk J Med Sci 2004.  Buccal Corticotomy for Closure of Oro-Antral Openings -
Case Report

JOMS 2005. Bony Press-Fit Closure of Oro-Antral Fistulas - A Technique for
Pre-Sinus Lift Repair and Secondary Closure

W Ind Med J 2005.  A New Surgical Management for Oro-Antral Communication.  
The Resorbable Guided Tissue Regeneration Memebrane - Bone Substitute
Sandwich Technique

BJOMS 2007.  Incidence & predictive factors for perforation of the maxillary
antrum in operations to remove upper wisdom teeth. Prospective multi-centre study

JSCR 2010.  Oro-Antral Fistula from Bisphosphonates-Induced Osteonecrosis of
the Jaw

J Int Oral Health 2010.  Treatment of Oro-Antral Fistula using Palatal Flap.  A Case
Report & Technical Note

BDJ 2011.  Oro-Antral Fistulae & Fractured Tuberosities

BJOMS 2011. Technical Note.  Closure of Oro-Antral Fistula using Auricular
Cartilage. A New Method to Repair an Oro-Antral Fistula

Eur Soc Radiology 2011.  Oroantral Fistulas.  CT Evaluation with Dentascan
software

JUMDC 2012.  Case Report.  Use of Buccal Fat Pad Oro-Antral Fistula Repair

Open Dent J 2012.  Surgical Options In Oroantral Fistula Treatment

Otolaryngology 2012.  Reliability of 2 Surgical Methods for Oro-Antral
Communication Closure.  A Clinical Study of 20 Patients

JOMS 2013.  Treatment of Oro-Antral Fistulas using Bony Press-Fit Technique


PowerPoint Presentation on OAC's
Various Treatment Modalities for the Closure of Oro-Antral Communications