Maxillary Sinus Disease of Odontogenic Origin

What Is a Sinus?

Air-filled cavities located around the nose are called sinuses.

What Is the Maxillary Sinus?

The maxillary sinuses are air-filled anatomical cavities located symmetrically on both sides of the nasal cavity within the upper jaw bone. First described by Nathaniel Highmore, the maxillary sinus is also known as the Highmore Antrum. It begins to develop in the womb and continues to expand downward and forward into the jawbone after birth until adulthood, taking on a pyramidal shape.

The maxillary sinus, which is in close proximity to the oral cavity and posterior teeth, has the following functions:

• Contributing to voice resonance
• Reducing pressure within the skull
• Decreasing the weight of the skull
• Warming and humidifying inhaled air

What Is Odontogenic Sinusitis (Tooth-Related Sinusitis)?

The sinus may sometimes be very close to the roots of the teeth, or the tooth roots may extend into the sinus cavity. An infection that develops in the teeth can therefore spread to the sinus and cause infection. In this way, sinusitis occurs.

Sinusitis presents with:

• Nasal congestion
• Yellow-green nasal discharge
• Postnasal drip
• Headache
• Reduced sense of smell

In such cases, both the sinusitis must be treated and the underlying cause must be eliminated. In tooth-related infections, the cause is treated either with root canal therapy or tooth extraction. After extraction of such teeth, an opening may form between the oral cavity and the sinus cavity. This is called an oroantral fistula.

What Is an Oroantral Fistula?

An oroantral communication is defined as an abnormal passage or pathological connection between the oral cavity and the maxillary sinus.

These connections between the maxillary sinus and the oral cavity are referred to as oroantral fistulas.

Opening of the maxillary sinus during tooth extraction is one of the complications frequently encountered by dentists. Since the premolar and molar teeth in the upper jaw are adjacent to the maxillary sinus, if proper care is not taken after extraction, the barrier between the sinus and the oral cavity may be lost, resulting in a pathological connection and an opening.

If an oroantral fistula develops, food consumed by the patient during eating may pass into the nasal cavity. Therefore, it should be closed without delay. If recognized during extraction, treatment is simple and easy; however, if detected later, surgical intervention is required for closure.

How Does the Maxillary Sinus Open After Tooth Extraction?

In the upper jaw, the roots of premolar and molar teeth may sometimes be located within the sinus. During extraction, the sinus floor may be perforated, creating an opening between the sinus and the oral cavity. If a blood clot fails to stabilize in the extraction socket, proper healing does not occur and an opening may persist. This condition is called an oroantral fistula. Treatment involves surgical closure of the area.

How Is an Oroantral Fistula – Opening Treated?

An oroantral fistula caused by extraction may heal spontaneously if the sinus is healthy and the opening is smaller than 1–2 mm. However, larger openings require surgical treatment.

Various methods have been developed for closing oroantral fistulas.

These methods are classified as:

• Distant flaps
• Local flaps
• Grafting techniques

Local flaps are used for small openings, while distant flaps and graft materials are used for larger defects. The most commonly used closure techniques are the buccal flap and the palatal flap.

In our clinic, the palatal island flap is most frequently used. It is a highly successful technique and does not cause narrowing of the soft tissue on the cheek side, which prevents complications for future prosthetic treatments. Other techniques used in the closure of oroantral fistulas include:

• Closure with Interseptal Alveolectomy (Modified DEAN Technique)
• Closure with Monocortical Bone Graft
• Autogenous Graft Technique
• Closure with Fibrin Adhesives
• Closure with Lyophilized Dura Mater and Fascia Lata
• Use of Intraoral Membranous Bone Grafts

What Should Be Considered After Oroantral Communication Closure Surgery?

• During the healing process, attention should be paid to the hygiene of the surgical area. Teeth should be brushed with a soft toothbrush and mouthwash should be used (except on the first day).
• To reduce swelling after surgery, apply a cold compress to the affected area at 5–10 minute intervals on the first day.
• For the first 48 hours, do not spit, avoid hot food and beverages, refrain from alcohol, spicy and acidic foods, and absolutely do not smoke.
• Do not draw water into the nose, do not blow your nose forcefully, do not sniff, do not sneeze with your mouth closed, and do not perform the Valsalva maneuver (the act of pinching the nostrils and trying to exhale forcefully).
• Do not shower on the first day. Avoid high-temperature baths, Turkish baths, and saunas for 2 weeks.
• Avoid air travel for 2–3 weeks.
• Do not engage in sports during the first week and avoid swimming in the sea or pool.
• Avoid diving for 2–3 weeks.
• Use the medications prescribed by your physician regularly.

How Much Does Oroantral Fistula Surgery Cost?

In order to determine the cost of maxillary sinus and oroantral communication treatment, a detailed oral and dental examination is required. Treatment costs vary depending on the clinic where the procedure is performed, the experience of the doctor, and the patient’s specific needs.

It is extremely important to consult experienced and specialized professionals to ensure that your oral and dental treatment is performed correctly.