Techniques for oro-antral closure

definition Oroantral communication: Abnormal connection between the oral and antral cavities. Its simply described as the unnatural communication between the maxillary sinus and the oral cavity. its one of the complications which can occur when doing extraction of the upper molar because sometimes their roots are close to the maxillary sinus.

causes Extraction of maxillary posterior teeth(most common) Tumor Cyst Trauma Osteomyelitis

Signs and symptoms Unpleasant tasting discharge and odor. Reflux of fluids and foods into the nose from the mouth. Leakage of air. Difficulty in tobacco smoking.

Clinical examination Inspection after hemostasis. Leakage of air while blowing against closed nostrils. Radiograph is usually used for confirmation, and to determine extent of the defect. NB: probing is generally not recommended, could cause perforation

Patients at high risk Extraction of maxillary 2nd molar. Periapical infection. Approximation of the maxillary sinus floor from the teeth apices.

Management Immediate management: the primary purpose is closure of the defect and prevention of sinusitis through: Suturing or periodontal pack Rinses with physiologic solution Rinses with antibiotic solvent Antibiotic prophylactic.

Management cont… Communication: During endodontic therapy: Infected canal: antibiotic, closure and filling Not infected canal: nothing (low risk of sinusitis) If sinusitis occurred: drainge through the root canal.

b) during tooth extraction: Prevention. <5mm: noninvasive intervention(spontaneous closure by blood clot) >5mm:surgical intervention c)During dentoalveolar surgery: Small: noninvasive wound closure Large: rotational flap. Extremely large: distant flaps(e.g. tongue flap)

surgical closure with flap techniques factors that determine surgical techniques: New communication or fistula Location and size of defect Height of the alveolar ridge Duration of sinus exposure. Presence or absence of sinusitis General health status of the patient.

surgical Buccal advacement flap techniques: closure with flap techniques Indications: 1.Minor communication. 2.Buccal defect. advantages: 1.Simplicity 2.Lower post-operative pain & discomfort. Disadvantages: 1.Thin flap 2.Limited extent.

surgical closure with flap techniques Palatal flap technique: Advantages: 1.More tissue attachment without tension. 2.Could be used with large defect. 3.Firmer and more resistant to trauma and infection. Disadvantages: 1.Possible flap necrosis. 2.More complicated technique. 3.Greater post-operative pain. 4.Appearance of roughness at donor site.

Name: Rana Mabrouk ID: 5210092