Dentistry: Treatment of Oro-antral Fistula
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Questions and Answers

What is the recommended treatment for early cases of oro-antral fistula where no fistula has formed and only communication has occurred?

  • Caldwell-Luc operation
  • Immediate primary closure by sliding buccal flap (correct)
  • Supportive treatment of decongestants, mucolytics, antibiotics, and analgesics
  • Surgical closure along with Caldwell-Luc operation

    • What is the purpose of placing a gauge packed in medicaments like white head varnish in oro-antral fistula treatment?

  • To clean the edge of the fistula
  • To promote healing of the fistula
  • To drain out the pus
  • To prolong surgical closure, especially when root piece has to be retrieved at a later date (correct)

    • What is the treatment approach if a patient comes within 24 hours of oro-antral fistula development?

  • Postpone the treatment for 3-4 weeks until the gingiva has healed
  • Perform Caldwell-Luc operation
  • Advise supportive treatment of decongestants, mucolytics, antibiotics, and analgesics
  • Clean the edge and achieve primary closure by sliding buccal flap technique (correct)

    • What is the treatment approach for chronic oro-antral fistula?

    <p>Surgical closure of the opening along with Caldwell-Luc operation</p> Signup and view all the answers

    What is the purpose of advancing a buccal flap in oro-antral fistula treatment?

    <p>To close the whole opening</p> Signup and view all the answers

    What is the type of flap advancement procedure used in oro-antral fistula treatment?

    <p>Von Rehrmann flap</p> Signup and view all the answers

    What is the step involved in the buccal flap advancement procedure?

    <p>Excising the whole fistulous tract along with some soft tissue margin</p> Signup and view all the answers

    What is the post-operative care involved in the buccal flap advancement procedure?

    <p>Suturing over firm bone</p> Signup and view all the answers

    What is the most common cause of oro-antral fistula?

    <p>Pushing of tooth or root into the sinus while extracting it</p> Signup and view all the answers

    What is NOT a symptom of oro-antral fistula?

    <p>Blurred vision</p> Signup and view all the answers

    What is the aim of treatment for oro-antral fistula?

    <p>To protect sinus from microorganisms</p> Signup and view all the answers

    What is NOT a sign of oro-antral fistula?

    <p>Fever</p> Signup and view all the answers

    What is used in the diagnosis of oro-antral fistula?

    <p>All of the above</p> Signup and view all the answers

    What is a possible complication of oro-antral fistula?

    <p>All of the above</p> Signup and view all the answers

    What is NOT a cause of oro-antral fistula?

    <p>Dental caries</p> Signup and view all the answers

    How is oro-antral fistula treated?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of the Caldwell-Luc procedure in managing chronic maxillary sinusitis?

    <p>To remove only the diseased mucosa from the sinus</p> Signup and view all the answers

    What is an oroantral fistula?

    <p>An unnatural communication between the oral cavity and maxillary sinus</p> Signup and view all the answers

    What is the purpose of nasal decongestants in the Caldwell-Luc procedure?

    <p>To prevent gross edema</p> Signup and view all the answers

    What is the typical anesthesia used for the Caldwell-Luc procedure?

    <p>General anesthesia</p> Signup and view all the answers

    What is the location of the incision in the Caldwell-Luc procedure?

    <p>Along the mucogingival sulcus in the canine fossa</p> Signup and view all the answers

    What is the primary indication for the Caldwell-Luc procedure?

    <p>Treatment of chronic maxillary sinusitis</p> Signup and view all the answers

    What is the tool used to make a hole in the canine fossa during the Caldwell-Luc procedure?

    <p>Bone gauge</p> Signup and view all the answers

    What is the purpose of the antral curette in the Caldwell-Luc procedure?

    <p>To remove only the diseased mucosa from the sinus</p> Signup and view all the answers

    Study Notes

    Treatment of Early Cases (Iatrogenic Opening)

    • Immediate primary closure by sliding buccal flap and acquiring enough soft tissue to cover the whole opening
    • Supportive treatment with decongestants, mucolytics, antibiotics, and analgesics is recommended

    Treatment Measures to Prolong Surgical Closure

    • Gauge packed in medicaments like white head varnish is sutured and held in position till surgery
    • Acrylic stent is placed in position till surgery

    Treatment of Delayed Cases (Chronic Fistula)

    • If patient comes within 24 hours, edge is cleaned and primary closure is achieved by sliding buccal flap technique
    • If patient comes after 24 hours, treatment is postponed for 3-4 weeks until the gingiva has healed and is fit for surgical procedure
    • If patient comes after gingival has healed (chronic fistula), surgical closure of the opening along with Caldwell Luc operation is done

    Surgical Closure

    • Done by advancing either buccal flap or palatal flap, or combination of both
    • Caldwell-Luc operation may be done to retrieve root piece or drain out pus

    Buccal Flap Advancement Procedure (Von Rehrmann Flap)

    • Whole fistulous tract is excised along with some soft tissue margin
    • Trapezoidal buccal flap is reflected to close the whole opening
    • Sutures are placed over firm bone and post-operative care is taken

    Caldwell-Luc Operation

    • Done for treatment of chronic maxillary sinusitis, management of oroantral fistula, repair of fracture of orbital floor or zygoma, and management of hematomas of the sinus with active bleeding through the nose
    • Procedures include:
      • Making an intraoral incision of 2.5 cm along the mucogingival sulcus in the canine fossa
      • Making a hole at the centre of the canine fossa of the size of index finger using a bone gauge and ronguer
      • Draining blood and pus from the sinus, removing foreign bodies, and removing only the diseased mucosa
      • Cleaning the cavity and replacing the soft tissue flap, which is sutured over the bone

    Oro-antral Communications (Oro-antral Fistula)

    • Unnatural communication between the oral cavity and maxillary sinus
    • Etiology includes:
      • Pushing of tooth or root into the sinus while extracting it
      • Periapical abscess, leading to destruction of bony floor of sinus
      • Improper use of instruments leading to damage of sinus floor
      • Trauma to face
      • Surgical removal of cysts, polyp, or tumor of maxillary sinus
      • Osteomyelitis of sinus
      • Infected maxillary implant denture
      • Malignant diseases

    Clinical Features

    • Symptoms:
      • Nasal discharge from posterior region of nasopharynx into the mouth, leading to fowl taste
      • Epistaxis (unilateral bleeding from nose)
      • Change in voice due to enhanced column of air
      • Pain in the region
      • Popping out of an antral polyp in chronic cases
    • Signs:
      • Tenderness over maxilla
      • Edema over cheek and infraorbital region
      • Otitis media (middle ear infection)
      • Fowl odour and halitosis
      • Nasal congestion

    Diagnosis

    • Clinically:
      • Part of bony floor of sinus seen along with extracted tooth apex
      • Close nose and blow inward, bubbling of air in the oral opening of fistula or the blowing of cotton kept in the area is seen
    • Radiographic evaluation
    • Rhinoscopy

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    Related Documents

    Maxillary Sinus Disorders Lecture Notes PDF

    Description

    Learn about the treatment of oro-antral fistula, including immediate primary closure and supportive treatment with decongestants, mucolytics, antibiotics, and analgesics.

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