Name of the Procedure:

Repair Fistula; Oromaxillary (combine with 31030 if antrotomy is included)

Summary

In layman's terms, this procedure involves fixing an abnormal connection (fistula) between the mouth (oral cavity) and the maxillary sinus. It often entails surgically closing the fistula and may include creating an opening in the sinus (antrotomy) for better access and drainage.

Purpose

This procedure addresses the presence of a fistula between the oral cavity and the maxillary sinus, which can cause infections, fluid leakage, and discomfort. The goal is to close the fistula, thereby preventing these issues and restoring normal function and comfort.

Indications

• Recurrent sinus infections
• Persistent drainage into the mouth from the maxillary sinus
• Pain and tenderness in the area
• A visible or symptomatic opening in the oral cavity leading to the maxillary sinus

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments to medication regimens, especially blood thinners, may be required.
• Pre-procedure assessments such as imaging studies (CT scan or X-ray) of the sinus area.

Procedure Description

1. Administration of local or general anesthesia to ensure patient comfort.
2. An incision is made inside the mouth to access the fistula.
3. The surgeon carefully closes the fistula using sutures.
4. If an antrotomy is needed, the surgeon creates a small opening in the maxillary sinus to drain fluids or access the area better.
5. The surgical site is then closed, and the area is disinfected.

Duration

Typically, the procedure lasts about 1 to 2 hours, depending on the complexity and whether antrotomy is included.

Setting

The procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Oral and Maxillofacial Surgeon or an ENT specialist
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Recurrence of fistula
• Pain and swelling around the surgical site
• Complications related to anesthesia

Benefits

• Alleviation of chronic infections and fluid drainage
• Improved comfort and oral function
• Prevention of future complications associated with the fistula

Recovery

• Post-procedure pain and swelling managed with medications
• Instructions to maintain oral hygiene and avoid certain foods
• Follow-up appointments to monitor healing
• Full recovery typically takes several weeks, with most patients resuming normal activities in a few days.

Alternatives

• Non-surgical management with medications and draining techniques (less effective for long-term resolution)
• More invasive surgical procedures if the fistula is complex

Patient Experience

During the procedure, patients may be under anesthesia and will not feel pain. Post-procedure, they might experience some discomfort, swelling, and have restrictions on eating and drinking. Pain management will be provided, and most discomfort usually subsides within a few days.