Surgery for an Oroantral Fistula - Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the indications for closure of an oroantral fistula?

In general, most small oroantral (oromaxillary) fistulas will close spontaneously without any additional intervention. In patients with a persistent communication between the mouth and the sinus that is symptomatic (foul tasting discharge, reflux of air or food into the sinus, or development of a sinus infection), surgical repair is indicated to close the fistula. In cases of an active and concurrent sinus infection, sinus surgery is often performed at the same time in order to allow an alternative route of sinus drainage into the nose and to allow the fistula to remain closed after surgery.

Figure 1: A patient with a left oroantral fistula after a tooth extraction eight months prior. There is chronic sinusitis due to constant contamination of the sinuses.

What is closure of an oroantral (oromaxillary) fistula?

The goal of surgery is to close off the communication between the sinus and the mouth. This can be achieved with a simple excision of the sinus tract and direct closure of the mucosa in the mouth. In cases of a large oroantral fistula, tissue is often borrowed from the palate and the cheek (local flaps) and moved over the defect to cover the fistula. The procedure is performed entirely through the mouth. Often, a limited maxillary sinus surgery is performed if there is evidence of an active sinus infection to allow the maxillary sinus to drain into the nose and reduce the drainage into the mouth while the repair is healing.

Figure 3. The above patient had surgical repair of the fistula. The oroantral fistula is identified with communication between the mouth and the maxillary sinus and a local flap is elevated (left). The fistula is closed with dissolvable sutures (right).

What should I expect before surgery?

• If you have an active infection, your physician may prescribe preoperative medications to optimize the condition of your sinuses for surgery. The medications may include antibiotics and/or oral steroids.
• DO NOT TAKE THE FOLLOWING MEDICATIONS FOR AT LEAST 14 DAYS PRIOR TO SURGERY: aspirin, ibuprofen (Motrin/Advil), naproxen (Aleve), other non-steroidal anti-inflammatories (NSAIDS), vitamin E (multivitamin is OK), gingko biloba, garlic (tablets), and ginseng. These medications can thin the blood and create excessive bleeding. Tylenol is safe and may be taken any time up to the day of surgery. St. John's wort should also be avoided for 2 weeks prior to surgery because of possible interactions with anesthesia medications. If you take the blood thinner Coumadin or Plavix, you must discuss this with your surgeon so the medication can be discontinued before surgery and restarted appropriately.
• While our office will make every attempt to keep your primary care physician informed before and after your surgery, it is important that you personally inform him/her that you are planning to have sinus surgery. If you have underlying medical conditions, your primary care physician may help to clear you medically for surgery. Most of the necessary pre-operative testing will be performed at Bellevue ENT during your preoperative visit. This takes place approximately 1 week prior to your surgery if needed.
• Due to the frequently changing operating room schedule, the surgery center will usually call you one business day before your surgery date to inform you of your surgery time. You are usually expected to arrive two hours prior to your surgery to check in.

What should I expect during surgery?

Your surgical team will include your surgeon, an anesthesiologist, a scrub nurse, a circulating nurse, and additional supporting staffs dedicated to ensuring that your surgery is safe. Closure of an oroantral fistula is typically performed under general anesthesia and will usually last about one hour. In cases where the fistula is small and does not need a local flap, the procedure may be completed with local anesthetics. The procedure is performed entirely through the mouth and dissolvable sutures are usually placed. If sinus surgery is performed at the same time, the sinus portion will be performed through the nose.

What should I expect after surgery?

• After your surgery, you will spend approximately 1-2 hours in the recovery area. Approximately 1 hour after you arrive in the recovery area, a family member or friend should be able to visit with you. Most patients feel well enough to go home the same day. You should not drive yourself home and you need to arrange for transportation prior to surgery.
• You can expect mild bleeding for 1-2 days after surgery. Pain can generally be controlled with over the counter Tylenol; however, narcotic (prescription) medication will be provided for additional control if needed.
• You may eat a soft diet for one week and transition to a regular diet thereafter.
• You will have return visits to the ENT clinic at approximately 1 and 6 weeks after surgery. At your first post-operative visit, will examine your mouth and wound site. If sinus surgery is performed, the doctor will examine your sinuses with an endoscope and may clean your sinuses of dried blood. Please write down any questions you may have so that we can answer them at your appointment.
• You should plan on taking 2-3 days off from work and ideally have a half-day planned for your first day back.
• Please see the post-operative instructions for additional details.

What are the risks of surgery for an oroantral fistula?

As with any surgical procedure, closure of an oroantral fistula has associated risks. With meticulous planning and appropriate precautions, complications from an oroantral fistula are very rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. Please refer to the sinus surgery handouts for additional information regarding the risks of sinus surgery. The risks of a closure of an oroantral fistula may include:

• Recurrence of disease: Meticulous planning is employed to maximize the successful closure of an oroantral fistula. In the setting of an active sinus infection, concurrent sinus surgery will reduce the risk of recurrence. While rare, a recurrent fistula may occur and will require additional procedures.
• Other risks: Other uncommon risks of surgery include dental injury, tongue injury, bleeding, and numbness of the soft palate.

What restrictions will I have during the postoperative recovery period?

• DO NOT BLOW YOUR NOSE for the first week after surgery. You may sniff back. If you need to sneeze, do not suppress it. Rather, sneeze with your mouth open. After 1 week, you may gently blow your nose.
• Maintain a soft diet for one week while the flap is healing.

Your surgeon is committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of your condition and treatment plan. Please feel free to ask questions about any aspect of your care. Learn more about oroantral fistula, sinus surgery, and post-operative instructions for closure of an oroantral fistula.

Learn more about oroantral fistula, postoperative instructions after an oroantral fistula closure, sinus surgery, and postoperative instructions after sinus surgery.