Oroantral Communication Research Paper

The oroantral communication (OAC) is a pathological condition that consists of an open connection between the oral cavity and the maxillary sinus. It’s a complication which most frequently caused by the extraction maxillary posterior teeth. [1] Since the maxillary sinus occupies an a large part of the maxilla, the roots of these teeth are close to it. The controversy revolves around maxillary molars, first molar and second molar. The chances of occurrence of oroantral communication increases, if there is an underlying periapical infection or a preexisting sinus disease. [2]
Signs and symptoms
Common clinical symptoms of oroantral communication include:
⎯ Unpleasant tasting discharge and odor
⎯ Reflux of fluids and foods into the nose from the
mouth
⎯ Leakage of air
⎯ Difficulty in tobacco smoking
The presence of these symptoms can be an indicator for diagnosis, although some patients remain asymptomatic. In case of new oroantral communication was created by extracting a tooth, the communication between the cavities can be confirmed by careful visual inspection with a dental mirror and good light. [3]
Cause
Dental procedures such as extraction of maxillary teeth can be a main causes f OAC.
Since the maxillary sinus is known for its thin floor walls and proximity to the posterior maxillary teeth. OAC can happen for many other reasons such as:
⎯ Displacement of posterior maxillary molar roots into antrum,
⎯ Direct trauma.
⎯ Acute or chronic inflammatory lesions
⎯ Necrotic lesions of the maxilla
⎯ Failure of sublabial incision to heal
⎯ Multiple and extensive fractures of the facial region
Diagnosis
Diagnosis may be confirmed by a positive nose blowing test (patient blows the nose gently by pinching their nostrils to occlude the nostrils; passage of air through the sinus floor leads to bubbling of blood in the extraction socket). Avoid forceful blowing of the nose and never probe the socket floor as these measures may create an OAC when none is present prior.
Complications
Following the creation of an oroantral communication, the communication diameter usually decreases over time but often the ‘tract’ from the antrum to the mouth fails to heal and becomes lined by epithelium. Once this occurs the communication is referred to as a fistula. This fistula acts as a pathway for infection and can result in the development of acute sinusitis which further prolong the healing
process.
Prevention
In case of extracting the maxillary tooth, a preoperative radiographic evaluation is essential. The risk of OAC is increased in the following situations:
⎯ Nearness of the roots of the tooth to the maxillary sinus
⎯ Marked pneumatization of the sinus
⎯ Teeth with lesions close to the sinus floor
Therefore, in such cases the following should be applied:
⎯ Avoid excessive apical pressure during extraction
⎯ Perform a surgical extraction with sectioning of the roots; consider referral to Oral Surgery clinic (Plymouth) or OMFS at the local hospital.
Treatment
An oroantral communication (OAC) is a common complication in alveolar surgery that usually occurs because of the extraction of maxillary posterior teeth. To avoid further complications, several closure techniques are used; most of them need a flap elevation [4] Moreover, the treatment strategies for can be subsequently divided in the following groups; autogenous soft tissue grafts, autogenous bone grafts, allogenous materials, xenografts, synthetic closure and other techniques. [1]
Hence, determining how to treat an OAC there are several aspects should be considered;
⎯ the size of the communication
⎯ the time of diagnosing
⎯ the presence of an infection
Furthermore, the selection of the treatment strategy is influenced by the amount and condition of the tissue available for repair. [1]
However, Surgical therapy of OACs has several disadvantages, such
as:
• The need for surgical expertise and equipment
• postoperative pain and swelling
• a permanent decrease of the buccal sulcus depth