What are oronasal or oroantral fistulas? - DVM
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What are oronasal or oroantral fistulas?

DVM InFocus

Case 1:

Blackie, an 18-year old male domestic shorthaired cat, presented with reduced appetite for approximately three weeks and for having sneezing episodes after eating and drinking. Blackie seemed to be interested in food, but he would eat small amounts and run from the food dish. After each sneezing episode, Blackie rubbed his face and eyes. The client was worried about Blackie's quality of life and had considered euthanasia.

Laboratory and clinical findings:

> BUN 29 mg/dl and Creatinine 1.0 mg/dl.

> Electrolytes were within normal limits.

> ALT 100 U/L (normal reference range=12-130) and ALKP 22U/L (normal reference range=14-111).

> Totoal Thyroxine (TT4)4 2.7ug/dL (normal reference range=1.9-4.8).

> Heart rate 100 beats/minute.

> ECG and Doppler blood pressure were normal.

Photo 3: Blackie's oral lesion.
> Oral examination revealed an oral lesion (Photo 3).

Photo 4: Alveolar osteitis.
> Dental radiographs demonstrate alveolar osteitis (Photo 4).

> Periodontal probing was normal.

Photos 5 and 6: Note the soft-tissue defect and the underlying bony defect.
> Clinical photos with flap exposure demonstrate the soft tissue defect and the larger underlying bony defect (Photos 5, 6).

Diagnosis: Oronasal fistula was secondary to dental extraction.

Treatment plan: Mucogingival flap closure of oronasal defect.

Photo 7: Blackie's repaired and healed oronasal fistula.
Result: Blackie returned to normal eating and the flap healed very well (Photo 7).

Comment: The owners were pleased with the surgical repair of the oronasal fistula. They were grateful to their veterinarian for offering the referral. The dental consultation helped the owners better understand the diagnosis, prognosis and treatment plan.

Case 2:

Jabba, a 13-year-old dachshund with chronic periodontal disease and extreme halitosis. The owner had noted sneezing since Jabba was approximately three years old.

Laboratory and clinical findings:

> Blood work results were within normal limits.

Photo 8: One of Jabba's large irregular lesions.
> Oral examination revealed debris within a large oronasal fistula in the area of a previously extracted right upper canine tooth (Photo 8). The left side was similarly affected.

Photo 9: Radiograph of the bony defect.
> Dental radiographs revealed bony changes at the defect (photo 9).

> Periodontal probing penetrated deep into the respiratory tract.

Diagnosis: Oronasal fistula.

Photo 10: Note respiratory tract debris.
Treatment Plan: The bony defect was approximately 2.5 cm by 1 cm. To create a mucogingival flap closure, the adjacent premolar teeth were extracted. Notice the debris within the respiratory tract on the enhanced radiograph (Photo 10).

Photos 11 and 12: A mucogingival flap closure was performed in two layers for each fistula.
Treatment: A mucogingival flap closure was performed in two layers to repair fistulas. (Photos 11, 12).

Result: The surgical sites healed well. The owner reported that Jabba was eating better and had improved energy levels since the oronasal fistula repair.

Comment: Oronasal fistulas are particularly common in dachshunds.

Dr. Dale Kressin operates the Animal Dental Center in Oshkosh, Wis. He is a diplomate of the American Veterinary Dental College and provides a conforming residency recognized by the American Veterinary Dental College.


Source: DVM InFocus,
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