Patient undergoes traumatic extraction one month ago
The patient is a 54-year-old lady from Chennai in Tamil Nadu, India. She had developed pain in the right upper back teeth region around a month ago. An x-ray was taken at an outpatient clinic of a dental school and she had been advised extraction of the right upper second molar. It had been a very difficult extraction and the entire tooth had been removed in pieces.
Subsequently, the patient had experienced swelling in the region followed by heaviness on the right side of her face. She described a feeling of having fluid flowing from the right side of her face down her throat. Her family had subsequently made enquiries regarding the best dental hospital in Chennai and were referred to our hospital.
Our hospital is a premier oral and maxillofacial surgery center in India. Many patients come to our hospital after unsuccessful surgeries elsewhere. We are renowned for corrective maxillofacial surgery in India. Hundreds of patients with chronic maxillofacial problems have been successfully rehabilitated in our hospital.
Initial examination upon presentation at our hospital
Dr SM Balaji, Oral and Maxillofacial Surgeon, examined the patient and ordered pertinent imaging studies including a 3D CT scan. The patient stated that she has a history of maxillary sinusitis. Her imaging studies revealed that her maxillary sinus was filled with an exudate. There was also an oroantral fistula present at the site of the traumatic extraction.
In addition, a full thickness defect was also noted on the bony nasal septum. The patient had previously undergone a septoplasty approximately three years ago. Nose blowing test was positive.
Oroantral communication versus oroantral fistula
An oroantral fistula is an abnormal condition where the maxillary sinus is exposed to the oral cavity through an epithelialised fistula. This is a pathologic condition and is not to be confused with oroantral communication. An oroantral communication, if left untreated, can either heal spontaneously or progress into oroantral fistula. The fistulous opening is in a majority of cases situated on the alveolus.
Treatment planning explained and consent obtained
It was decided to perform an oroantral fistula closure along with clearance of exudates from the maxillary sinus. Caldwell Luc procedure is the ideal surgery for this condition. The surgery was explained in detail to the patient. She then provided consent for the surgery.
Surgical closure of the oroantral fistula
Under adequate general anesthesia, a crevicular incision was first made in the right maxillary region. A flap was then elevated and the oroantral fistula exposed. There was purulent discharge within the antrum. Through Caldwell Luc technique, a window was created and thorough maxillary sinus clearance was done.
Irrigation was done with antibiotics and thoroughly flushed until there was return of clear irrigant. The flap was then reapproximated and sutured using resorbable sutures.
Successful resolution of symptoms and antral infection
There was no residual fullness felt by the patient. She expressed that all her symptoms had completely resolved and she felt completely fine. The patient expressed her happiness at the results of the surgery and thanked the surgical team before final discharge from the hospital.
Surgery Video
