Closure of an oroantral communication

The roots of the upper back teeth often lie very close to the floor of the maxillary sinus, and sometimes extend into it. After such a tooth is removed, an opening can form between the mouth and the sinus: an oroantral communication. Food, liquid and bacteria pass through it into the sinus, which risks sinusitis (inflammation of the sinus). Closing the communication restores the barrier between the mouth and the sinus. At UKRMED it is performed in the maxillofacial surgery department.

Photo: Database Center for Life Science (DBCLS), Wikimedia Commons, CC BY-SA 2.1 jp

Why the sinus gets perforated

A sinus perforation is a break in the sinus floor. It most often happens:

• during tooth extraction in the upper jaw when the roots sit in the sinus;
• with inflammation and cysts (fluid-filled cavities) around root tips;
• with injuries and fractures of the upper jaw;
• during procedures in the sinus area.

Signs of a communication

• liquid or air passes from the mouth into the nose;
• when blowing against a pinched nose, air comes out through the tooth socket;
• the voice changes and becomes nasal;
• bad smell and discharge from one side of the nose;
• pain and pressure in the cheek.

If you notice water entering your nose after an upper tooth extraction, do not rinse vigorously, do not blow your nose hard and see a surgeon as soon as possible.

What happens without treatment

A small communication sometimes closes on its own under a blood clot. But if the opening is large or does not heal, its edges become lined with mucosa (the moist lining of the mouth) and a permanent tract forms: an oroantral fistula. Infection keeps entering the sinus and chronic sinusitis develops. Then, as well as closing the fistula, the sinus may need cleaning with maxillary sinusotomy.

How the surgery is done

1. Diagnostics. The surgeon examines the area and orders a 3D CT scan of the upper jaw to assess the size of the opening, the condition of the sinus and any roots or foreign bodies inside.
2. Preparation. If the sinus is inflamed, the inflammation is treated first.
3. Closure. The opening is closed with local tissue, most often a cheek mucosa flap (a section of lining partly lifted and stretched over the opening) or the buccal fat pad (a small pad of fat inside the cheek) moved over the defect. The flap is carefully sutured for a watertight seal.
4. Recovery. You receive instructions and come for follow-up visits.

A review of closure techniques shows that the method depends on the size and position of the opening and on whether a fistula has formed, so surgery is planned individually. Repairing an established fistula follows the same principle, but the surgeon also removes the altered edges of the tract.

Who performs it

UKRMED's maxillofacial surgery department includes surgeon Anna Kravchenko, PhD, qualified in implantology and bone grafting. Please check which doctor will perform your surgery when booking. The surgery is done under anaesthesia. Whether it can be done under sedation in your case is decided by the surgeon and anaesthetist at the consultation.

After surgery

• for 2 weeks, do not blow your nose hard and sneeze with your mouth open;
• do not drink through a straw or play wind instruments;
• avoid baths, saunas and heavy exercise;
• eat soft food and chew on the other side;
• take prescribed medicines and attend check-ups.

When the area has fully healed, the missing tooth can be replaced, for example with an implant. The surgeon decides on timing based on a CT scan.

Prices

Sources

1. Visscher S. H., van Minnen B., Bos R. R. Closure of oroantral communications: a review of the literature. J Oral Maxillofac Surg, 2010. https://doi.org/10.1016/j.joms.2009.07.044
2. Hanazawa Y., Itoh K., Mabashi T., Sato K. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg, 1995. https://doi.org/10.1016/0278-2391(95)90329-1