5. • Nasal regurgitation of liquid
• Unilateral epistaxis
• Altered vocal resonance
• Bad taste in the mouth
• Inability to blow out the cheek
• Unilateral malodrous nasal discharge
• Delayed symptoms!!!!!
6. Ask the patient to pinch his nostrils and blow
Mirror fog test
Cotton wisp test
Passage of fluid from the nose????
Inability to blow mouth
9. The choice of the appropriate therapy must
take into consideration the
width, epithelialization and presence or
absence of infections.
Defects less than 3mm in width and without
epithelialization might heal spontaneously in
the absence of infections
Communications wider than 5mm require
the use of rotating and sliding flaps to
provide closure.
10. Immediate surgical repair
(preserve the blood clot)
Antibiotics (penicillin with β-
lactamase inhibiors)
Local decongestants (methanol
or benzoin)
Analgesics
Anrtral triage
13. Defer the operation untill the gingival edges
of the fistula have healed soundly (approx 3
weeks)
Provisional procedure
Prophylactic treatment
14. Re-establish the drainage of maxillary sinus
Supportive medical treatment
When the acute condition has subsided
surgical repair of the fistula should be carried
out.
15. Local flaps
Distant flaps
Bone grafts
Alloplastic materials
Third molar