Surgery Overview

An oromaxillary fistula is an abnormal passageway between one of the sinuses on either side of your nose (maxillary sinuses) and the roof of your mouth. It may develop as a birth defect (linked with a cleft palate), as a complication of removing a tooth, or from infection or trauma. Sometimes the roots of a tooth are so close to the bone under a maxillary sinus that the bone is damaged when the tooth is removed. This can open a passage between the mouth and sinus.

Before surgery, you may have an imaging test, such as a computed tomography (CT) scan, to help the doctor plan your surgery.

A surgeon may choose one of several techniques to close the fistula. One of the most common methods is called flap advancement. It involves cutting a U-shaped flap of skin in the side or roof of the mouth (sometimes both) and stretching the flap over the fistula. Sometimes a surgeon will place a piece of medical-grade foil over the opening and then stitch the skin flap over the foil.

You probably will have general anesthesia, which means you will be unconscious during the operation.

What to Expect After Surgery

Your doctor will prescribe antibiotics to prevent infection and a decongestant to keep the sinuses clear. You probably will take these medicines for a week to 10 days.

You will be given a list of precautions to follow to avoid changes in pressure between the mouth and nasal passages. Be sure to keep your mouth open when you sneeze. And don't smoke, blow your nose, or suck on items such as straws, hard candy, or ice.

Why It Is Done

This surgery is done to close a fistula between a maxillary sinus and the mouth. A fistula can cause chronic inflammation or infection of the sinus (sinusitis).

How Well It Works

Most people who have this surgery recover with no problems.

Risks

Infection is the main risk of this surgery. You should call your doctor if you have:

• Increasing pain.
• Bleeding.
• A headache.
• Pus.
• A fever of 101°F (38.3°C) or higher.

What to Think About

In some cases, a very small fistula may be treated without surgery. A dentist or oral surgeon may apply gauze or another product over a blood clot that forms in the hole left by the extracted tooth. The gauze stays in place for a few days to help the wound heal.