- Panoramic radiographs can also be used to confirm the presence of an OAC. If simple radiographs are deemed not to give enough information, cone beam computed tomography (CBCT) (special x-ray equipment that can scan in 3 dimensions) may be used. Imaging can help locate the communication, determine the size of it and can give an indication as to whether there is any sinusitis and foreign bodies in the sinus. - Normally clinicians should be cautioned against probing or irrigating the site a newly formed OAC as this may reduce the chance of spontaneous healing. - Valsalva test (nose blowing test) The patient is asked to pinch their nostrils together and open their mouth and then blow gently through the nose. The clinician must observe if there is passage of air or bubbling of blood in the post extraction alveolus as the trapped air from closed nostrils is forced into the mouth through any oroantral communication. Gentle suction applied to the socket often produces a characteristic hollow sound. However, there are differing opinions about the appropriateness of carrying out this test. It can be argued that by performing this test, a small OAC may be made bigger thus preventing spontaneous healing. Causes
Extraction of maxillary teeth
The maxillary sinus is known for its thin floor and close proximity to the posterior maxillary (upper) teeth.
One option is construction of a denture with an acrylic base plate or extension of the patient’s existing denture to protect the socket and support the clot. These options are particularly helpful in patients who smoke as it provides protection from smoke inhalation. The socket can also be sutured over with mattress sutures if there is adequate soft tissue available. Medication
Medications may be needed as an adjunct to assist the closure of the defect. Antibiotics can help control or prevent any sinus infections. Preoperative nasal decongestants usage can reduce any existing sinus inflammation which will aid surgical manipulation of the mucosa over the bone. Postoperative care
Following all methods of OAC/OAF closure, the patients are instructed to avoid activities that could produce pressure changes between the nasal passages and oral cavity for at least 2 weeks due to risk of disruption to the healing process. Nose blowing and sneezing with a closed mouth are prohibited. A soft diet is also often advocated during this period. Following surgery, nasal decongestants and prophylactic antibiotics are often prescribed to prevent postoperative infection. References


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