สถาบันวิจัยระบบสาธารณสุข

Oroantral fistula (OAF) is a pathological connection between the maxillary sinus and the oral cavity. The condition mostly follows extraction of postcanine teeth in the maxilla because of the close relationship between the apex of those teeth and the floor of the maxillary antrum. An accurate history and physical examination and proper investigation should be performed to rule out possible contributing factors, e.g. previous sinonasal infection and inflammation, benign or malignant neoplasms or osteomyelitis. If these are present, appropriate treatment should be performed before closure is attempted. Although smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always require surgical closures. Procedures involving local flaps are usually adequate to close minor-to-moderate- size defects. The buccal mucoperiosteal advancement flap is the simplest and most effective way of closing OAF. The palatal rotation flap has also been a popular choice. Wound breakdown and flap necrosis are the most common complications of OAF repair. Careful preservation of the flap’s blood supply and tension-free wound closure are the keys to avoiding these complications.