Definition: Oro-antral fistula is an epithelized, pathological, unnatural communication between the oral

cavity and maxillary sinus.

Causes Signs & Symptoms
 Injudicious use of the 1.Escape of fluids & epistaxis.
elevators 2.Escape of air during sucking, smoking
 Extraction of upper teeth 3.Excruciating pain & popping out of
 Malignant tumors polyp & systemic toxicity (fever,malaise)
 Extensive trauma to face. 4.Persistent mucopurulent discharge.
Local Soft Tissue Flaps
Buccal Advancement Flap Palatal Transpositional
(von Rehrmann 1936) Flap ( Ashley 1939)
Indications:
• Used when buccal
advancement flap failed
• When the OAF is situa-
etd palatally.
Advantages:
• Very thick, strong & well
Indication:
vascularised.
• Does not affect vestibu-
Most commonly used flap
lar depth
for closure of OAF.The
flap is elevated & the Disadvantages:
periosteum is released & 1. Large area of exposed
bone takes a long time to
the flap is extended over
the defect and sutured. heal 2. Flap shrink on
Disadvantage: elevation 3. GP artery
may be damaged
Reduction in depth of the
sulcus of vestibule.
Diagnostic Test
 Nose blowing test
 Mirror fog test
 Cotton wisp test
 Radiographs :
1. Water’s View 2.OPG
Distant Flaps
Combined Buccal & 1. Buccal Pad of Fat
Palatal Flaps
Step 1
Step 2
A larger buccal flap is taken
after excising the fistula. A
pedicled portion of the
buccal fat pad is gently
placed over the defect and
sutured with a round body
needle.
Advantage: Shows good
Step 3 rate of epithelization & low
failure rate.
Disadvantage: Chances
of traumatising the pterygo
maxillary space
2. Temporalis Muscle Flap
3. Nasolabial Flap
4. Temporo-parietal
Galeal Flap
Palatal Island Flap
The greater palatine artery is
dissected from the flap which
is excised and then sutured
over the bony defect
Indications:
1.It is used for closure of
palatal defects formed after
surgical excision of tumors
2.very posteriorly situated
OAF.
Tongue Flap
Also a Distant Flap
Mainly of two types:
1.Anteriorly based tongue flap
2.Posteriorly based tongue
flap
Dibya Falgoon Sarkar, Roll No. 24 (NBDC&H)
Management
Step 1: We have to eliminate
any acute/chronic sinus infection
before surgical closure of OAF.
This can be done by:
• Antral lavage (Normal saline)
• Antibiotics (Amoxycillin)
• Nasal Decongestants (0.5%
Ephedrine nasal drops)
• Antihistamines
• Analgesics (Ibuprofen
400mg)
• Construct a acrylic denture
plate to prevent food entry.
If disease persists we have to go
for Caldwell-Luc procedure.
Step 2: After elimination of the
sinus infection we can excise the
chronic fistulous tract
 Adequate local anesthesia is
given by local infiltration
 Fistulous tract is excised with
a 3-4mm margin, sutured
together if possible, &
inverted into the sinus cavity
Step 3: Now we can close the
bony defect by Flap elevation or
by using Free Grafts
Bone Grafts
Autogenous Bone Grafts
used for closure of OAF:
1.Iliac Crest 2.Ribs
3.Cancellous bone from mandible