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