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Volume3 Issue3
S
upporting
Y
our
P
ractice
andconsider usingaGelfoam® sponge toobturate the
opening.
•
If thearea is infected, consider antibiotics and
decongestants.
•
Includepostoperative instructions toavoidnoseblowing,
smoking, etc., so thecommunicationdoesnot reopen.
•
For a
large fracture
: consider dissecting the tooth
from thebony segment immediately (if possible) and
stabilizing the segment by suturingprimarily. Thiswill
likely requiremanagement of aconcomitant oroantral
communication.Management of a large (4mmor greater)
oroantral communicationmay require themobilization
of local flaps, autogenousor allogenicbone, or theuseof
syntheticmaterials. Suchprocedures aremore specialized
and referral toanOMFS ishighly recommended. For
very
large segments that includemultiple teeth
: consider
stabilizationbywiring it to theadjacent teeth, allowing
the segment toheal for 6 to8weeks and then returning
for theextraction inamorecontrolled fashion. Referral to
anOMFS for stabilizationandeventual extraction ishighly
recommended.
•
Advisepatient about possibleoroantral fistula formation,
sinusitis, andpoorer retention for eventual prostheses.
a
Suggestedresources
1. HuppJR.Preventionandmanagementofsurgicalcomplications. In:HuppJR,EllisE,TuckerMR,editors.
Contemporaryoralandmaxillofacialsurgery.5thed.St.Louis(MO):Mosby;2008.p.185-200.
fractured segment (in centimetres andnumber of teeth
involved).
•
Determine the sizeof the communication into the sinus.
•
Document the situationwithperiapical or panoramic
radiographs. The fracturemaybedifficult todetect on
radiograph; however, baselinefilms to assesspost-compli-
cationprogress are important.
Diagnosis
1.
Confirmedmobilityof fracture fragments
2.
Radiographicevidenceof fracture
3.
Sizeof the fractured segment, dimensions in centimetres
andnumber of teeth
4.
Sizeof the communication into the sinus, whendetected
Treatment
The following shouldonlybeusedasgeneral guidance. Inall
situations, referral toanoral andmaxillofacial surgeon (OMFS)
shouldbeconsidered, particularly if therearepathoses, systemic
considerations, ora large fractureor sinuscommunication.
•
For a
small fracture
without sinusperforation: dissect the
segment fromgingivaandperiosteumand suture.
•
For a
small fracturewith sinusperforation
(less than3 to
4mm): dissect the segment andclose the socket primarily
