management of oral-antral

communication , fistula
and maxillary sinusitis

abdulaziz Mansour Alharbi

391108720
PBL 1
Oroantral fistula (OAF) refers to an abnormal connection between the oral
cavity and antrum (or maxillary sinus).

The creation of an OAC is most commonly due to the extraction of a maxillary (upper)
tooth (typically a maxillary first molar.
 Differences between OAC and OAF

OAC    OAF   
Connection between oral cavity and antrum that is Connection between oral cavity and antrum that has
not epithelialised. epithelialised.
Develops from OAC that has  not healed has not been
May develop immediately following the extraction of
closed surgically, or initial attempts at surgical closure
maxillary tooth that is close to antral floor.
have failed.
Requires surgical closure if large to prevent
Requires surgical treatment to remove and close the
development of a persistent OAF and chronic
fistula.
sinusitis.
1.Surgery TREATMENT
Surgical methods are required if a large defect is present or if a defect persists.

There are a number of different flaps that can be used such as the buccal advancement flap, the buccal fat pad
flap, a combination of the two and a palatal flap.

A-Buccal advancement flap

The buccal advancement flap involves cutting a broad based trapezoid shaped mucoperiosteal flap with
two vertical incisions. The flap is cut buccally, is three sided and extends to the full depth of the sulcus.
 B-Buccal fat pad flap

The buccal fat pad flap is also a popular option due to its high success rate. It is a simple procedure where
the buccal extension of the anatomical fat pad is used for closure.

2-Non-surgical interventions

Non-surgical methods can be used to encourage the growth of oral mucosa

between the oral cavity and the antrum. The aim of these methods is to
protect the blood clot within the socket and help to prevent infection.

Drug Therapy
•Amoxicillin (500 mg/adults) 3 times daily for at least 1 week
Use Clindamycin in penicillin-allergic patients. 
The maxillary sinuses are located behind your cheek bones and are amongst the largest of your
paranasal sinuses. It is also the most common place for your to develop a sinus infection.
 Maxillary Sinusitis Treatment

Maxillary Sinusitis Treatment usually includes antibiotics if the infection is caused by bacteria.
If your Maxillary Sinusitis is caused by a viral infection, you will not be prescribed antibiotics as they are not
an effective medication to treat this type of infection

Decongestants can help to clear nasal passages by

reducing swelling.
Other remedies for the relief of Maxillary Sinusitis include warmA salt water nasal wash (also repeated 3-4 times
daily).
Steam treatments with a hot bowl of water and towel over your head while breathing in the steam, help to keep
your nasal and sinus passages moist.
 References

 Khandelwal P, Hajira N (January 2017). 

"Management of Oro-antral Communication and Fistula: Various Surgical Options". World Journal of Plastic
Surgery. 6 (1): 3–8. PMC 5339603. PMID 28289607.
 Sandhya G, Reddy PB, Kumar KA, Sridhar Reddy B, Prasad N, Kiran G (September 2013). 
"Surgical Management of Oro-Antral Communications Using Resorbable GTR Membrane and FDMB Sandwich Techni
que: A Clinical Study"
. Journal of Maxillofacial and Oral Surgery. 12 (3): 254–9. doi:10.1007/s12663-012-0437-8. PMC 3777032. PMID 
24431851.
 Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, Little P (December 2007). 
"Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial"
. JAMA. 298 (21): 2487–96. doi:10.1001/jama.298.21.2487. PMID 18056902.
THANK YOU