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Oro-antral repair |
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Treatment of OAC and OAF
Immediate treatment— closure if diagnosis is made at time of extraction. Close the socket by suture or buccal advancement flap, give antibiotics and decongestants, and advise not to blow nose.
If > 2 days after extraction—place on antibiotics for 2 weeks, give decongestants and avoid nose blowing. Review in 6 weeks. May have closed, if not repair.
Repair techniques: 1. Buccal advancement flap Excise fistula with a blade. Prepare a line of closure over bone and raise a broad-based buccal flap. Incise periosteum to allow mucosa to stretch over the socket and close over bone. Suture with vertical mattress sutures. Use antibiotics etc. Remove sutures at 10 days.
2. Palatal rotation flap Excise fistula, dissect a palatal mucoperiosteal flap based on the palatine artery and rotate over socket. Suture with a vertical mattress suture, leave palatal bone to granulate.
3. Buccal fat pad flap Raise the buccal advancement flap, open the periosteal incision with artery forceps to expose the buccal fat pad. Mobilise a pedicled flap and suture to cover defect.
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