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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).

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:

  • Palatal Rotational Advancement Flap most common.
  • Others include Palatal Pedicle Island Flap (Henderson),
  • V-shaped Palatal Flap (Krueger) &
  • Split-Thickness Palatal Flap (Ito & Hara).

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

Useful Articles & Websites

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

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003.  Use of third molar transplantation for closure of the oroantral communication after tooth extraction.  A report of 2 cases

Swiss Med Wkly 2003.  The reconstruction of oral defects with buccal fat pad

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 Membrane – Bone Substitute Sandwich Technique

Intl J Oral Maxillofac Surg 2006.  Evaluation of different treatments for oroantral & oronasal communications – experience of 112 cases

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

Internet J Dent Sci 2008.  A Comparison between Submucosal Connective Tissue Palatal Flap and Conventional Pedicle Palatal Flap for the Closure of Oroantral Fistulae

JOMS 2009.  Closure of Oroantral Communications with Bichat’s Buccal Fat Pad

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

JOMS 2010.  Closure of Oroantral Communications – A Review of the Literature

JOMS 2010.  Closure of Oroantral Communications Using Biodegradable Polyurethane Foam – A Feasibility Study

Med Oral Patol Oral Cir Bucal. 2010.  Oroantral Communications.  A Retrospective Analysis

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010.  Buccal Pad of Fat & its Applications in Oral & Maxillofacial Surgery – A Review of Published Literature 2004 to 2009

Pakistan Oral & Dent J 2010.  Treatment of Oroantral Fistula & A Study

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

Int J Dent Clinics 2011.  Use of Palatal Rotation Flap in the Closure of Oroantral Communication

J Maxillofac Oral Surg 2012. Surgical Management of Oro-Antral Communications Using Resorbable GTR Membrane & FDMB Sandwich Technique. A Clinical Study

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

J Clin Exp Dent 2015.  Alternative Surgical Management of Oroantral Fistula using Auricular Cartilage

Int J Oral Health Med Res 2015.  Surgical Closure of Oro-Antral Fistula (OAF) using Buccal Fat Pad Graft – A Case Report & Review of Literature

Acta Otorrinolaringol Esp 2016.  Case Study.  Odontogenic Sinusitis, Oro-antral Fistula & Surgical Repair by Bichat’s Fat Pad – Literature Review

Annals of Otolaryngology & Rhinology 2016.  Etiology & Management of Oro-Antral Fistula. 

Cochrane Database of Systematic Reviews 2016.  Interventions for Treating Oro-Antral Communications & Fistulae due to Dental Procedures (Review)

J Craniofac Surg 2016.  Surgical Treatment of Oro-Antral Communications

Intech 2016.  Management of the Oroantral Fistula

Intl J Adv Res 2016.  Double layered flap for closure of recurrent oroantral fistula using buccal fat pad & palatal pedicled flap – a case report

Int J Sci Study 2017.  Closure of Oroantral Communication Using Buccal Advancement Flap – A Case Report

World J Plast Surg 2017.  Management of Oro-antral Communication & Fistula – Various Surgical Options

Int J Adv Res 2018.  Treatment Techniques for Oro-Antral Communications & Fistulas

PowerPoint Presentation on OAC’s