Latest update January 8th, 2025 2:00 AM
ORO-ANTRAL COMMUNICATION
By Dr. Neromini Fagu
You may find it surprising to hear that your nasal passage is connected to your mouth. Have you
X-ray showing roots of molar in maxillary sinus
ever drank something and then coughed violently or laughed really hard only to have the liquid contents come through your nostrils? The anatomy of our face is such that we have open passages connecting our nose to our mouth and air spaces (sinuses) in our top jaw (maxilla).
The maxillary sinus is located below the eye sockets and in the area of the cheek bones. The sinus is an open space filled with air. The roots of the maxillary molars and premolars sit right below the sinus. The sinus is lined by a membrane and is separated from the tooth socket by a bony floor which varies in thickness and may be entirely absent in some cases. This bone may be damaged by infection or certain dental treatments causing an opening between the sinus and the mouth. This abnormal opening is called an “oro-anthral communication” (OAC).
If it goes unhealed it may turn into anoro-antral fistula (OAF) and may result in long-lasting sinus infections.
An OAC is a potential complication during an upper molar or premolar extraction. This is especially so if the roots of a tooth are close to or extend into the sinus. Part of the bony floor may be removed with the tooth, or it may be perforated. If your dentist took an x-ray before the extraction, the relationship showing the tooth roots compared to the sinus would be evaluated and potential risks for any communication would be discussed.
The signs and symptoms of an OAC may vary depending on the size of the communication but may include:
• Initial pain which may return if there is an infection
• A non-healing extraction site
• Escape of food or fluid from your mouth up into your nose
• Escape of air or fluid into the mouth from your nose
• Sinusitis due to saliva and bacteria from your mouth getting into your nose
• Pain and tenderness of the area under your eye/upper cheek
• A blocked nose and discharge on the one side.
The most commonly heard complaint is that there is a dull throbbing pain in your top jaw on the one side only. You may notice pressure that goes up to your eye and most of your upper teeth on that side causing the teeth to be tender when biting. You may also experience a runny or blocked nose on the one side. The pain may continue for a couple of weeks after the tooth extraction and affect your sleep.
Your dentist may determine if you have an OAC by conducting the Valsalvin test. This test is performed by asking the patient to blow air through the nose after pinching the nose closed. The patient must keep the mouth open. The air could be heard hissing out of the fistula. Also a blunt probe may be used to gently probe the area in question.
X-rays may be used to look for root fragments in the sinus.
Treatment of an OAC
If it is suspected or confirmed that you have an OAC, the aim would be to prevent a rise in air pressure in the sinus. Air introduced in the area, for example due for example to sneezing or blowing your nose, will be forced down through the hole and into your mouth causing the condition to worsen or prevent healing of the communication.
Your dentist will caution you to avoid blowing your nose and that when you sneeze to allow the air pressure to escape out of your mouth and not hold it in. A decongestant, antibiotic and antibacterial mouthwash may be prescribed and you must carefully follow all post extraction advice.
Depending on the size of the perforation, surgical intervention such as flaps and graphs may be necessary.
If root fragments have been dislodged into the sinus, they may be removed if they have not perforated the lining. Otherwise, a more difficult approach may be needed and you may be referred to a specialist. Most OAC may heal on their own but it is imperative that you closely follow your dentist’s instructions advice for the healing period.
For more information contact OMNI DENTAL at 295 Quamina Street, Georgetown Tel: 227-0025, Parika Tel: 260-3133 or send emails to [email protected].
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