Oroantral communication after extraction — ORE Part 1 MCQ

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HardOral SurgeryOroantral communication after extractionORE Part 1

A 45-year-old patient reports fluid passing from the mouth into the nose after extraction of an upper first molar. Gentle socket inspection shows bubbling when he exhales through the nose with the nostrils pinched. The pre-operative radiograph showed divergent roots close to the maxillary sinus floor. What is the most likely diagnosis?

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Correct answer: A — Oroantral communication

The diagnosis is oroantral communication (OAC). The stem presents three diagnostic pillars: (1) iatrogenic timing—post-extraction of an upper first molar, the most common cause; (2) pathognomonic clinical signs—fluid regurgitation from mouth to nose combined with bubbling on socket palpation during nasal expiration, confirming an abnormal oral–antral tract; (3) predisposing radiographic anatomy—divergent roots in close proximity to the sinus floor, a recognised risk factor. These findings are diagnostic of OAC, an abnormal gap between the maxillary sinus and oral cavity. Alveolar osteitis presents with pain and odour, not fistula. A maxillary sinus mucocele is a rare benign lesion unrelated to extraction. Palatal torus fracture is rare and does not cause oro-nasal communication. Nasopalatine duct cyst is a midline asymptomatic lesion unrelated to acute post-extraction complications.

Reference: Management of Oroantral Fistulae and Communications: Our Recommendations for Routine Practice, PMC 2022 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692004/); Fixation of Flowable Composite Resin Within Crossing Sutures for the Closure of Oroantral Communications, PMC 2024 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226162/)