Oro-antral communication

The creation of a OAC most commonly follows the extraction of a maxillary tooth closely related to the antral floor (typically the first upper molar roots), which lies closes to the lowest point of the antral floor. An OAC may also form as the result of an alveolar fracture running through the antral floor or wall, of be due to direct trauma from a bur or chisel, a cyst or infection from an upper tooth. Left untreated the OAC may heal spontaneously or persist as a OAF. Signs after extraction:

A visible defect between the mouth and antrum Bone fragments with a smooth concave upper surface (antral floor fragments) adhering to the root of
the extracted tooth Investigations: Careful examination using a mirror and good light, although bleeding may obscure visibility. The interior of the antrum may be visible and gentle suctioning of the socket often produces a hollow sound. Avoid probing or irrigation. Ask patient to blow against closed nostrils, forcing air into the mouthwatch for bubbles of saliva or blood from the socket. Radiographs are useful to confirm the diagnosis and to assess size of lesion, although small lesions may not be visible. Symptoms of a OAC:

Salty tasting discharge or unpleasant smell Reflux of fluids and foods into the nose from the mouth Escape of air when blowing nose Recurrent or chronic sinusitis on affected side Difficultly playing a wind instrument or smoking a cigarette
Prevention of a OAC Where there is a risk of creating an oro-antral communication it is prudent to warn the patient beforehand. Surgical exodontia is preferable as it allows more controlled bone removal. If a mucoperiosteal flap is raised it should designed to allow repair of the OAC, should repair be necessary.

An oro-antral communication is an abnormal connection between the oral and antral cavities; an oro-antral fistula is an epithelialised connection.