WHAT IS MAXILLARY SINUS?
The maxillary sinus is formed by anatomic spaces filled by air that are symmetrically located in the upper jaw bone at both sides of the nasal cavity. Since maxillary sinus is first described by Nathaniel Highmore, it is also known as antrum of Highmore; its formation begins in the womb of the mother and it takes the pyramid configuration due to extension and expansion of the jaw bone downwards and onwards after the birth until it takes the adult form. Maxillary sinus is located close to the mouth cavity and posterior teeth and it functions by contributing to the voice resonance, decreasing the pressure and weight of the skull and warming and humidifying the inhaled air.
HOW DOES MAXILLARY SINUS OPEN AFTER EXTRACTION OF TOOTH? /Oroantral Fistula
The roots of the premolars and molars of the upper jaw are, sometimes, located inside the sinus. After the teeth are extracted, the base of the sinus opens, resulting in formation of a fistula between the sinus and the mouth cavity. Healing fails and opening forms as the clot cannot adhere to the space left after the extraction. This is called oroantral fistula. The treatment is the surgical closure of this formation.
WHAT ARE OROANTRAL FISTULA; OPENING and PERFORATION?
Opening of the maxillary sinus due to extraction is one of the complications that dentists face frequently. As premolars and molars of the upper jaw are located close to the maxillary sinus, the barrier between the sinus and the oral cavity disappears and they combine pathologically and an opening occurs. This is called oroantral fistula (oroantral communication, oroantral perfusion) If oroantral fistula occurs, the food that the patient eats can pass to the nasal cavity. So, it should be closed immediately. If it is recognized when the tooth is extracted, treatment will be easy and simple, while surgical procedure is required for late closure.
TREATMENT OF OROANTRAL COMMUNICATION, FISTULA?
Oroantral fistula that develops due to the extraction will recover spontaneously if the sinus of the patient is healthy and smaller than 1-2 mm. Surgical procedure is required, if the opening is larger. Various methods are developed in order to close oroantral fistula. These methods are classified as distant flaps, local flaps and grafting. Local flaps are used for the small communications, while distant flaps and graft materials are preferred for large communications. The most common closure methods are buccal flap and palatal flap. Palatal islet flap is most commonly used in our clinic. It is a substantially successful technique; it does not cause problems for prosthesis that are placed in the future until the fistula does not cause narrowing in the soft tissue around the cheek. The other techniques used in the closure of the oroantral fistula are;
- Closure with Interseptal Alveolectomy (Modified DEAN Technique)
- Monocortical Bone Graft Closure Method
- Autogeneous Graft Method
- Closure with fibrin adhesives
- Closure with Lyophilized Dura Mater and Fascia Lata
- Intra-oral Membrane Bone Grafts.
CONSIDERATIONS AFTER OROANTRAL COMMUNICATION CLOSURE SURGERY?
– In the recovery period, hygiene of the operation area should be paid attention; teeth should be brushed with soft brush and gargling should be done (except the first day)
– Intermittent cold compression at 5- to 10-minute intervals is required in order to relieve the postoperative pain. Spitting and cold foods and drinks as well as alcohol and spicy and acidic foods should be avoided for the first 48 hours; smoking should be strictly quit for the same period.
– Water should not be sniffed; nose should not be forced cleaned, nose should not be blown. Patient should not sneeze mouth open and Valsalva maneuver should not be performed. (Valsalva maneuver implies forced exhaling by pinching nostrils..)
– No shower is allowed on the first day; hot bath should be avoided for 2 weeks. Turkish bath and sauna are banned.
– Flights should be avoided for 2 to 3 weeks.
– No sport or swimming in sea or pool is allowed for the first week
– Diving should be avoided for 2-3 weeks.
– It is necessary to take medications regularly that are advised by the physician.
OROANTRAL DEFICIENCY, FISTULARS SURGERY PRICES?
For detailed information on treatment costs of oroantral opening, fistula, please call us at 0216 363 36 36 for our Clinic in Bağdat Avenue, 0212 280 88 00 for Levent Clinic and 0216 485 90 30 for Acarkent Clinic. For further information, please inform us your e-mail using E-Newsletter section below.