Surgery Overview
An oromaxillary fistula is an abnormal passageway between one of
the sinuses on either side of your nose (maxillary sinuses) and the roof of your
mouth. It may develop as a birth defect (linked with a
cleft palate),
as a complication of removing a
tooth, or from infection or trauma. Sometimes the roots of a tooth are so close
to the bone under a maxillary sinus that the bone is damaged when the tooth is
removed. This can open a passage between the mouth and sinus.
Before surgery, you may have an imaging test, such as a
computed tomography (CT) scan, to help the doctor plan
your surgery.
A surgeon may choose one of several techniques to close the
fistula. One of the most common methods is called flap advancement. It involves
cutting a U-shaped flap of skin in the side or roof of the mouth (sometimes
both) and stretching the flap over the fistula. Sometimes a surgeon will place
a piece of medical-grade foil over the opening and then stitch the skin flap
over the foil.
You probably will have
general anesthesia, which means you will be
unconscious during the operation.
What to Expect After Surgery
Your doctor will prescribe
antibiotics to prevent infection and a decongestant to
keep the sinuses clear. You probably will take these medicines for a week to 10
days.
You will be given a list of precautions to follow to avoid changes
in pressure between the mouth and nasal passages. Be sure to keep your mouth
open when you sneeze. And don't smoke, blow your nose, or suck on items such
as straws, hard candy, or ice.
Why It Is Done
This surgery is done to close a fistula between a maxillary sinus
and the mouth. A fistula can cause chronic inflammation or infection of the
sinus (sinusitis).
How Well It Works
Most people who have this surgery recover with no problems.
Risks
Infection is the main risk of this surgery. You should call your
doctor if you have:
- Increasing
pain.
- Bleeding.
- A
headache.
- Pus.
- A fever of
101°F (38.3°C) or higher.
What to Think About
In some cases, a very small fistula may be treated without surgery.
A dentist or oral surgeon may apply gauze or another product over a blood clot
that forms in the hole left by the extracted tooth. The gauze stays in place
for a few days to help the wound heal.
Other Places To Get Help
Organization
American Rhinologic Society
www.american-rhinologic.org
References
Other Works Consulted
- Tucker MR (2014). Odontogenic diseases of the maxillary sinus. In JR Hupp et al., eds., Contemporary Oral and Maxillofacial Surgery, 6th ed., pp. 382-393. St. Louis: Mosby.
Credits
ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Elizabeth T. Russo, MD - Internal Medicine
Specialist Medical ReviewerDonald R. Mintz, MD - Otolaryngology