Oral-sinus communications
Bucco-sinusal communication (BCS) is the abnormal continuity between the maxillary sinus and the oral cavity, to be distinguished from the communication between the nasal cavity and the oral cavity (nasosinusal communication). Most of the time, this communication can close on its own, but if it persists, a fistula is created, leading to surgery to close it.
Find out more about bucco-sinusal communication from Dr Delagranda, ENT surgeon at La Roche-sur-Yon in the Vendée.
Mouth, maxillary sinus and bucco-sinus communication (BCS)
Maxillary sinus: this is a pneumatized cavity (filled with air from the nasal cavities) in the maxillary bone, present from birth unlike other sinuses, which grows until the age of 15, in the shape of a pyramid with a lateral tip. An incomplete septum may be present in the maxillary sinus in 2.4% of cases. The maxillary sinus communicates with the nasal cavity via its natural drainage orifice or ostium, located at the level of the intersinonasal septum. The maxillary bone alone forms all the walls of the maxillary sinus, except for the intersinonasal septum, which it shares with the inferior turbinate, ethmoidal bone, palatine bone and lacrimal bone. The floor of the maxillary sinus forms the upper gum bone.
Sinus teeth: Sinus teeth are the upper premolars and molars, because their roots are implanted in the maxillary bone and may be in close contact with the maxillary sinus cavities, or even entirely in the sinus (antrals).
Bucco-sinusal communication: Bucco-sinusal communication (BSC) is the abnormal communication between a maxillary sinus and the oral cavity.
Causes of buccosinusal communication
The main cause of a BCS is a surgical procedure (iatrogenic cause = due to the action of a doctor/surgeon/dentist):
- Avulsion of a maxillary tooth. This happens most frequently with the avulsion of maxillary molars, as these teeth are often close to the maxillary sinus, or even antral, with roots entirely within the sinus.
- Any surgical procedure involving the maxillary sinuses: maxillary bone cyst removal, orthognathic surgery, pre-implant surgery (sinus floor elevation), dental apex surgery (apical resection), removal of cancer, benign tumors (osteomas).
The cause may also be medical (iatrogenic = due to the action of a physician):
- Following external cervico-facial radiotherapy: radiation can weaken bone by reducing vascularization (ischemia) and regeneration potential. This is known as osteoradionecrosis. Generally speaking, however, osteoradionecrosis is the result of bone surgery on a bone that has withstood irradiation, and will therefore not appear spontaneously.
- Osteoporosis is caused by antiresorptive drugs used to prevent bone resorption and remodelling in cancer: biphosphonates, anti-RANK-Ligand antibodies (denosumab), anti-angiogenic antibodies (sunitinib, bevacizumab), m-TOR inhibitors (rapamycin, everolimus, temsirolimus). This is known as osteochimionecrosis.
The cause can also be traumatic:
- Accidental loss of maxillary bone substance (road accident, sports accident, suicide attempt with firearms).
When should a bucco-sinusal closure be performed?
Bucco-sinusal communication closure mostly concern adults with a hole in the upper gum communicating with the sinus. Children are exceptionally concerned.
A bucco-sinusal communication closure should be performed in cases of :
- Persistent sensation of air passing into the mouth through a hole in the upper gum.
- Persistent leakage of thick liquid into the mouth through a hole in the upper gum.
- Passage of liquid food from the mouth to the nose via the maxillary sinus.
- Repeated unilateral maxillary sinusitis.
- Voice changes.
- Repeated bleeding into the mouth or nose (epistaxis)
Surgery and post-operative care
Objectives of bucco-sinusal communication closure?
- Stop the passage of fluid and food debris from the mouth to the maxillary sinus.
- Stop direct drainage from the maxillary sinus into the mouth.
- Stop repeated bleeding into the mouth or nose.
Surgical procedures
The procedure is performed under local or general anaesthetic, depending on the location and size of the BCS. The patient’s medical history may influence the choice of technique and whether or not general anesthesia is required.
Surgery is strictly endo buccal, with no scars on the face. Several surgical solutions are possible, depending on the situation:
- BCS post immediate or recent avulsion: Small extent (<5 mm): direct closure-stitches. Larger extent (>5 mm): cheek (vestibular) or palate (fibropalatine) mucosal flap.
- Chronic BCS: Small extent (<5 mm): Direct closure-suture using single-stitches, but with edge swelling to facilitate edge adhesion, and removal of necrotic bone. Larger (> 5 mm) and predominantly anterior: Cheek (vestibular) or palate (fibropalatine) mucosa flap.
- Greater extent (> 5 mm) and predominantly posterior: pedicled flap of the jugal fat body, known as Bichat’s ball, and in extreme cases a bone graft, bio-material, free flap or obturator prosthesis.
The surgeon may or may not decide to combine this procedure with a complementary one, which is indicated in some situations and consists of draining the affected maxillary sinus, either endonasally or via a meatotomy.
Post-surgery recovery period
In the case of outpatient surgery, the patient usually returns home the same day.
After hospitalization, you should remain at home for 8-10 days, resting and checking for nose and throat bleeding.
Food should be soft, cold and preferably chewed on the other side for 8 days.
Avoid hard, pungent or offensive foods.
The surgeon will give you a 7-day leave of absence from work if necessary.
Sport is not recommended for the first 2 days.
Do not blow your nose strongly for 15 days, as this may cause the BCS to reopen.
Rigorous oral hygiene is essential for a successful operation.
Do not smoke during the healing period, as there is a risk of recurrence, necrosis and superinfection in the operated area.
Meals should be taken slowly to avoid untimely biting of the flap.
Pain is moderate. Class I analgesics are used to control pain.
Complications associated with surgical closure of bucco-sinusal communication (BCS)
In addition to the risks inherent in any surgery involving general anaesthesia, CBS closure presents rare complications:
- Nasal haemorrhage (epistaxis) after the procedure, which is very minor and rapidly subsides with nose-blowing and nose-washing.
- Oral hemorrhage.
- Infection of the surgical site in the mouth and/or maxillary sinusitis
Reopening of the BCS is not a complication but rather a failure. A new attempt is necessary.
Please refer to the ENT College’s explanatory sheet on suspension laryngoscopy for further explanations:
Frequently asked questions
Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for oral-sinus communication closures in La Roche-sur-Yon.
Is surgery compulsory?
No, but it is strongly recommended to avoid sinusitis and improve living comfort.
Is the result immediate?
No, you need to wait several days to be sure you’ve closed the hole.
What precautions should I take immediately after the procedure?
Avoid smoking, use mouthwash, eat soft, lukewarm food slowly, and limit chewing on the operated side.
Fees and coverage of the procedure
Closure of bucco-sinusal communication is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda will be happy to answer any questions you may have about the closure of bucco-sinusal communication. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vendée.
ENT consultation for closure of bucco-sinusal communication in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about the closure of bucco-sinusal communication. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vendée.