Dog with Oronasal Fistula Repair
An oronasal fistula is an opening between the oral and nasal cavities that most commonly results from the extraction of a diseased upper canine tooth. The canine teeth are the long sharp teeth found at the anterior corners of the mouth on either side of the front incisor teeth. In this image you can see that the dental probe demonstrates a deep pocket of infection around the base of this canine tooth. It needs to be extracted. In some dogs with infected canine teeth the infection is so bad that it destroys the bone at the base of the tooth and once the tooth is extracted it leaves a hole or fistula between the oral and nasal cavities (an oronasal fistula). To prevent infection this needs to be covered up with a gingival flap. (see dental case August 2008)
Sometimes the gingival flap does not ‘take’ properly leaving a small oronasal fistula even after healing is completed as is seen in this image. In this case a new flap is required. Why is this important? -so that food material does not get trapped in this opening that would lead to both a local gum infection and a nasal infection leading to a runny nose.
In image 1, Dr. Fisher is using a scalpel blade to freshen the edges around the fistula and to create a new flap. Next a Freer elevator is used to raise the flap away from underlying bone (image 2).
Next, the fistula space is filled with Consil®, a synthetic bone graft particulate that encourages new bone formation.
Consil application is followed by suturing of the gum (gingival) flap to the surrounding gum tissue in order to cover the fistula.
The finished product! All sutures have been placed and the oronasal fistula is covered. This flap of gum tissue adhered well this time and healing was complete, thus preventing a possible source of chronic infection in the mouth and nasal passage.