Done By

Ahmad Yamin Hassan 200820175

Mehdi 200711869

 38 old patient had his last remaining tooth on the upper right quadrant removed with some difficulty 6 days ago . He is no presented with swollen cheek, he noted that he started smoking much more than the usual and felt salty tast in his mouth.

Oroantral Fistula Dry socket NASOPALATINE DUCT CYSTS Dental infection

Intolerable pain Foul odor blood clot disintegrates no supparation History of extraction within 5 days

Confirm diagnosis -extremely painful upon light palpation

 non-odontogenic cysts upper maxilla Etiologic factors Clinical symptoms are: salty taste swelling on the anterior part of the palate

 Buccal spase infection Periapical abcess

 Based on:1-Last remaining tooth on the upper right quadrant . 2-Removed with some difficulty 6 days ago. 3- No presented with swollen cheek. 4- Started smoking much more than the usual. 5- Felt salty taste in his mouth.

 The rate and degree of sinus pneumatization after tooth extraction.

 Salty-tasting discharge or the awareness of an unpleasant smell. Reflux of fluids and food into the nose from the mouth. Escape of air into mouth during nose blowing. Recurrent or chronic sinusitis on the affected side. A visible defect between the mouth and antrum . of soft tissue around the fistula. Proliferation Bone fragments with s smooth concave upper surface (antral floor fragments) adhering to the root of the extracted tooth.

1-Confirmed by carful examination using a mirror and a good light. 2-Gentle suction applied to the socket produce a characteristic hollow sound . 3-The temptation to confirm the presence of OAC by probing or irrigation should be resisted.

3- patient ask to blow the nose whilst pinching the nostrils . 4- OAFs often have small slit-like or pinhole oral opening conceal much wider underlying bony defects. 5- x-rays.

The underlying factors :exodontia (48%) tumours (18.5%) osteomyelitis (11%) Caldwell-Luc procedures (7.5%) trauma (7.5%) dentigerous cysts (3.7%) correction of septal perforations (3.7%)

Gingival tissues cant be approximated Post-op rgime is not followed Wound dehiscence Enucleationof a cyst May develop 4 6 weeks post-extraction. Problems with smoking, eating or drinking. Chronic maxillary sinusitis. Antral polyp herniating into oral cavity. Purulent discharge from nose.

 Large sinus Large and unfavourable shaped roots extending into the sinus Being older (over 40) A history of difficult extraction Periodontal disease (significant bone loss)

 1- patient should be warned pre operatively 2- surgical exodontia is preferable than forceps extraction 3- if mucoperiosteal flap is raised its design should allow it to be adopted for OAC repaire

Possible Complications
Chronic sinusitis

 Estimate the diameter of communication 1-2 mm: No treatment required as it will usually naturally heal. 2-4 mm: Carefully follow the patient after 1-2 weeks and advise to avoid straining the area (no holding back sneezes, no smoking, no use of straws, no pressure on the sinus). 5 mm or larger : requre surgary

1-this aims to encourage the regeneration of new bone between the oral and antral cavities. 2-protect blood clot within the socket till organization and bone formation take plase by extention existing denture or by acrylic base plate or ribbon gause 3- palatal and bucal mucosa may be held together with matress suture

1-the epithelium lining the fistula tract and soft tissue margine is excised 2-A broad base three sided buccal mucoperiosteal flap is cut and extend 3-periosteum lining the inner surface of flap cut parallel to and close to it's base 4-the palatal margine is slightly undermined and the wound close with mattress suture

 buccal fat pad 1-A broad base three sided buccal mucoperiosteal flap is raised and periosteum incised 2-using vestibular incision in the region of the upper first molar 3-the tissue advanced to cover bony defect and suture

 palatal rotation flap 1-the epithelial lining is excised 2- An elongated full thickness mucoperiosteal palatal flap which course of grater palatine artery with short distance ANT to OAC cut and raised. 3- the flap is sutured across the defect and area of expose bone cover by ribbon gause and suture

Antibiotic Decongestant nasal drop steam inhalation Antibiotic Amoxicillin (500 mg/adults) 3 times daily for at least 1 week For resistant infections consider using levofloxacin 500 mg once daily. nasal decondestions sympathomimetic drop such as ephedrine 0.5% for patient with monoamino oxidase inhibitor we can use pseudoephedrine tablet steam inhalation using hot water rather than boiling to avoid risk of scalding

THANKS ANY Q?