Oro-antal communication repair

What is an oro-antral communication or fistula?

Oro-antral communications are recognised complications (albeit uncommon) of upper molar extractions in particular. The “sinuses” we commonly refer to when talking about sinusitis are air-filled spaces within our upper jaws. The roots of molar teeth are not a million miles away from these spaces and sometimes when they are removed the result is a communication being created between the sinus and the mouth. The other name for the maxillary sinus is the maxillary antrum – hence the name oro-antral communication. When these communications are allowed to become better established, they become epithelium lined tracts, or oro-antral fistulae.

Symptoms of these communications can include:

• a “whistling” sound in the area;
• hypernasal speech;
• the sensation of air “escaping”;
• an inability to create negative pressure to suck fluids through a straw;
• reflux of fluids from the mouth out of the nose

How are these repaired?

I can repair these under either local anaesthesia (awake) or general anaesthesia (asleep), determined by your preference, medical co-morbidities and/or the size of the defect and complexity of the repair. Repairing these involves advancing gum over the opening and borrowing fat from the cheeks (a buccal fat pad and buccal advancement flap repair). In cases refractory to standard treatment, I can work in conjunction with colleagues in ENT to do joint repairs via oral and nasendoscopic approach, using cameras through the nose. These more complex cases will require general anaesthesia.

Are there any precautions after surgery?

For some time afterwards, it will be important to avoid nose-blowing and smoking, maintain optimum oral hygiene using antiseptic mouthwash, use regular nasal decongestants and a short course of oral antibiotics, all of which will be provided for you on discharge.