53015 - Oro-Antral Fistula Closure

The need for plastic closure of an oro-antral fistula arises when a patient develops an abnormal opening between the oral cavity and maxillary sinus—typically resulting from tooth extraction, trauma, or surgical complications—leading to symptoms such as nasal leakage of food or fluids, chronic sinus infections, speech difficulties, or persistent nasal discharge, requiring surgical sealing under anesthesia with assistance in a hospital setting to restore separation between these cavities and prevent ongoing issues. This procedure is indicated when conservative measures like spontaneous healing or temporary packing fail, critical in the maxillofacial region where an open fistula disrupts oral function, respiratory health, and quality of life due to the sinus’s proximity to the oral cavity and nasal passages.

Several specific scenarios highlight the necessity of this intervention:

• Post-extraction complication: Removal of an upper molar might inadvertently create a fistula if the tooth root penetrates the sinus floor, allowing food and bacteria to enter the sinus and cause recurrent infections, necessitating closure to halt this cycle.
• Traumatic injury: A facial trauma fracturing the maxilla could puncture the sinus, leading to an oro-antral communication that requires surgical repair to prevent chronic sinusitis or nasal regurgitation during eating.
• Surgical aftermath: Following maxillary tumour resection or cyst removal, a residual fistula might persist, impairing speech by allowing air to escape nasally, prompting a plastic closure to restore oral pressure and clarity.
• Chronic symptoms: Persistent nasal discharge or sinus infections in a patient with a known fistula, especially if immunocompromised, demand definitive repair to avoid systemic spread or worsening respiratory issues.

For instance, a patient who experiences liquid leaking into their nose while drinking after a recent molar extraction might require this procedure to close the fistula using a local flap, with the surgical assistant ensuring precise tissue alignment to prevent recurrence. In an aged care context, an elderly patient with a chronic fistula from a decades-old extraction could need this to stop sinus infections and improve eating comfort, particularly given their frailty and higher susceptibility to complications. By employing plastic surgical techniques—often involving mucosal flaps or grafts—this service seals the fistula, prevents bacterial migration into the sinus, restores normal oral and nasal function, and enhances patient well-being, making it an essential intervention for managing oro-antral fistulas within the maxillofacial framework.

Seals fistula, prevents sinus infections, and restores oral-nasal function.

Recovery of 3-4 weeks with swelling, soft diet, and sinus care; hospital stay typically required.