You are here:

Oral Surgery/Oral Antral Fistula Complications

Advertisement


Question
Dr. Teig,
In Setember 2012, I had the #3 tooth removed and prior to the extraction, was advised the tip of the root was compromising the sinus cavity. After a period of healing I noticed the communication between my mouth and sinus and had an oral surgeon close the area, taking tissue from between my cheek and gum.
I was advised he inserted a membrane in an effort to assist in the closure. After a period of time, I noticed the communication again. The oral surgeon advised me he was going to allow the area to heal up to ensure a successful second surgery. He waited approximately 6-7 months before conducting the second surgery, this time taking tisue from the roof of he mouth to close the opening. I was told, he would see if he needed to use something to graft he bone in order to complete the closure. The surgeon told me the hole was approximately the size of a dime (which I thought sounded unusually large?)
After 6-8 weeks, I noticed the communication was still there. I returned for an assessment by the surgeon's partner and was told the hole (bone?)was the same size as it was before the second surgery. I asked the surgeon if he used anything for grafting purposes but he didn't answer me.
He has now referred me to an ENT surgeon and said if there's any infection, the communication will not close however, he advised me that my sinuses were clear and free of infection at the time of the surgeries. The ENT surgeon (who works closely with the oral surgeon)advised me the oral surgeon could have used "half of the bone from my skull but if there's infection present, it won't close. The mucous will take the path of least resistance."
I'm of the opinion that the oral surgeon may have missed a beat by not using anything for grafting purposes during the second surgery (of course I could be wrong). I was told there was no infection at the time of either surgery yet, the communication will not close. It's been 21 months since the original tooth extraction and I'm no further along then I was when I had the tooth pulled. I read that these surgeries typically have a high success rate yet, I'm now faced with a third surgery. I'm rather frustrated and tired of having to go through surgery after surgery. How can this ultimately be resolved?
Thank you for your time.

Answer
Greg -  Of course, not being there during the surgery to correct the opening, I cannot be completely sure, but it sounds like the surgeon made one major mistake.  Although a membrane is not a bad technique, but it is imperative that before the actual closure, the surgeon needs to clean the sinus via a procedure, oral antrostomy, that cleans out the sinus.  That is imperative.  Even though no infection is there visually from the small opening into the  sinus from the root, there are frequently areas of inflammation and bacterial contamination within the sinus after a short period of time where the sinus is bathed with saliva from the mouth from the small opening.  If cleaning of the sinus via the antrostomy was done, the chances of healing were much better.  If bacterial inflammation was still there, the healing would not progress.  

So a membrane can help seal, but often a simple double flap technique, not using anything artificial, has a high rate of success.  Another surgery is obviously necessary, but the first thing that must be done by the surgeon or with the help of an ENT doctor if the surgeon is not familiar with that procedure,  is to have an oral antrostomy done, the sinus cleaned and packed with a material to prevent a build up of blood in the sinus.  A piece of the material is then placed  through a hole into the nose to remove that material (nasal antrostomy).  the blood soaked packing is removed after the opening from the socket is healing.  

So the closure of an oral antral fistula is often not planned correctly.  I am a "belt and suspender" surgeon who tries to prevent any secondary problems.  So the surgeon needs to do this correctly.  Maybe the surgeon is trained, but if not he needs assistance.

I am sorry if I have confused the issue, but a proper approach is the best to close the hole.  If you have additional questions, feel free to contact me again.  

Oral Surgery

All Answers


Answers by Expert:


Ask Experts

Volunteer


Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

©2016 About.com. All rights reserved.