oroantral fistula ... of E.N.T part ... Important

* def :
abnormal communication between oral cavity & maxillary sinus .
* causes :
1) Odontogenic : (commonest)
a- difficult extraction of 2nd premolar or 1st molar
b- resection of dental cyst
c- incision of dental abscess
2) Non-odontogenic :
a- inflammation ----> osteomyelitis
b- neoplasm ----> cancer maxilla
c- radical antrum operation (Culd wll luc's operation )
* types :
1) sublabial ---> in anterior wall of sinus
2) alveolar ---> in floor commonly at 2nd premolar & 1st molar
* symptoms :
1- unilateral regurge of fluid or food through nose
2- on blowing the nose ---> air comes from fistula in mouth
3- symptoms of maxillary sinusitis
* signs :
1- may be diagnosed immediately by the dentist after extraction
2- probe passes through the fistula ( not preferred ---> damage healing )
3- signs of sinusitis
* Invest. :
C.T. scan in coronal section
* Treatment :
-fresh (early) & small :
---> primary suture of mucosa & alveolar margin
or ---> flap closure of defect
- chronic cases :
Culd well luc operation (i.e. ttt of sinusitis )
+ fistulectomy
+close defect by buccal or palatal flap
* causes of failure of healing of fistula:
1- infection
2- malignancy
3- malnutrition
4- uncontrolled DM
5- radiotherapy
6- large size of fistula