Etiology and Management of Oro-Antral Fistula

Oro-Antral Fistula is a communication between Maxillary Sinus and Oral Cavity, Dental diseases has been reported recently in 30% of maxillary sinusitis cases, The Pathophsiology of Odontogenic Maxillary Sinusitis is different than inflammatory maxillary sinusitis. The aim of this article is to highlight the etiology, symptoms and management of Odontogenic sinusitis in addition management of Oro-Antral fistula. INTRODUCTION Intimate anatomical relation of upper teeth to maxillary sinus promotes the development of periapical or periodontal odontogenic infections into maxillary sinus. The Bony wall between maxillary sinus and teeth roots can vary in thickness from complete absence hence making the mucus membrane as a sole intervening barrier to a bony wall barrier with thickness up to 12 mm [1,2]. Maxillary sinusitis can occur after tooth extraction and hence communication with the oral cavity also it can occur following dental root canal treatment with mechanical injury of the maxillary sinus mucosa [3]. A meta-analysis made by Arias-Irimia [4] revealed that the most common causes of Odontogic maxillary sinusitis were iatrogenic (55.97%), periodontitis (40.38%), and odontogenic cysts (6.66%). Oroantral Fistulas accounts for 47.5% of cases within the iatrogenic group. The Molar region accounts for 47.68% of patients with maxillary sinusitis, the first molar tooth was the most frequently affected with incidence of 22.51%, followed by the third molar tooth17.21%, and the second molar tooth 3.97%.The second premolar tooth was affected in 5.96% of the cases. While the canine only participated in 0.66% of cases with maxillary sinusitis [5]. Recently Taschierietal suggested that Bacterial Biofilm of odontogenic origin might be involved in the etiopathogensis of maxillary sinusitis and the choice of therapy depends on the characteristics of the bio film for successful treatment [6]. Clinical Picture Unilateral Nasal obstruction, Rhinorrhea, and/or foul odour and taste are the most frequent symptoms of Odontogenic maxillary sinusitis [6]. Longhini and Ferguson reported that dental pains were only present in 29% of patients with odontogenic maxillary sinusitis. There is no single symptom that can differentiate between dental from inflammatory chronic maxillary sinusitis.