| This complication can occur in any location
from the upper canines, caudally. Oro-nasal refers to a communication
between the oral and nasal cavity - most commonly at the site of the
maxillary canine. Oro-antral refers to a communication between the
oral cavity and the maxillary sinus - most common following upper
premolar 4 (carnassial) extraction. They are most common where the
bone plates are thinnest - either naturally or after periodontal or
metabolic disease.
Correct attention at the time of extraction can limit the need
for complex flap surgery later.
Debride socket gently with 0.05% chlorhexidine gluconate (CHX Solution™:
St Jon VRx Products) and fill with alloplastic graft material if
a solid floor is present. This may require a mesh type product (BioSyst™)
followed by BoneGlass (Consil™). Suture tissues should be sutured
without tension. Treat with suitable antibiotics.
Review after four to six weeks to identify the need for flap surgery.
This timeframe will allow for wound contraction.
The main reasons for dehiscence of flaps are:
- Chronic osteitis at site from local infection
- Tension on sutures
- Suture lines unsupported and located over a void.
Expect 20% contraction of soft tissue during healing. Tension on
flaps is usually due to poor flap design. To prevent this, ensure
that the releasing incisions are made off the target tooth, preferably
at the line angle of the teeth rostrally and caudally, and that
the flap is sufficiently undermined before suturing.
Many ONF's stay open due to the pressure differential between the
nasal and oral cavities. After six weeks, if the ONF is large enough
to cause chronic rhinitis and sneezing, closure by flap surgery
is indicated.
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