Animal Dentistry & Oral Surgery Specialists LLC


Dale Kressin DVM, FAVD, Dipl AVDC 
Steve Honzelka DVM, Resident
Joey Buhta DVM, Intern

Serving Oshkosh-Green Bay-Milwaukee-Minneapolis & Metropolitan areas
920-233-8409  888-598-6684

 







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American Veterinary Dental College

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American Veterinary Dental Society

Minnesota Veterinary Medical Association


Wisconsin Veterinary Medical Association

 since 1983
Dr. Kressin previously on WVMA Executive Board

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Milwaukee Veterinary Medical Association

Northeast Wisconsin Veterinary Medical Association

Oronasal and oroantral fistula in cats and dogs

Oronasal fistulas are a common clinical presentation for Dr. Kressin and other veterinary dental specialists.  Oroantral fistulation is less common however an important problem for companion animals.

What is an oronasal fistula?

 

Oronasal fistula near dental           Close up view of oranasal fistula.
extraction site.



Hair was impacted into the respriatory tract.

An oronasal fistula is a communication between the oral cavity and the anterior respiratory track.  Oronasal fistulas occur most commonly in the area of the upper canines and with less frequency in the incisor region.  Food and oral fluids perculate into the respiratory track.  The result is respiratory track inflammation and infection.

What is an oroantral fistula?

An oroantral fistula is a communication between the oral cavity and the caudal respiratory track.  These fistulas occur in the area of the upper fourth premolar and the molar teeth.

What is the cause of oronasal and oroantral fistulas?

The loss of the integrity of the either the incisive, maxilla or palatine bones results in the fistula.  Preiodontal disease is an infectious, progressive and destructive process typically responsible for these fistulas.  Trauma, especially from bite wounds or dental extraction are also common causes for oronasal and oroantral fistulas.

How can oronasal and oroantral fistulas be prevented? 

Oronasal and oroantral fistula formation can best be avoided with a team approach consisting of the owner (in providing daily teeth brushing), the family veterinarian and Dr. Kressin, the dental specialist.  Early diagnosis of periodontal disease is accomplished by the primary care veterinarian performing periodontal probing and in taking dental radiographs during professional teeth cleaning procedures.  This early diagnosis allows for early and appropriate periodontal therapy.

Clinical cases of oronasal fistula

 



This is a case of an oronasal fistula that developed as a result of a traumatic occlusion caused by a base narrow canine

Notice the food material found in the oronasal fistula.

 

Due to the location, this is a very challenging oronasal fistula to close. The closure was done in two steps.  The first step was to extract several teeth and allow this to heal before closing.

 

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Dog; oronasal fistula as a result of trauma.
The initial fistula was closed and reopened
due to incisive bone necrosis (death) (dehisced).

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A tension free mucogingival flap resolved
the fistula. Suture; 4-0 Monocryl.

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"Jabba" fell and luxated the right canine
tooth.  The tooth was extracted however
the surgical defect could not be closed.

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"Jabba"; an oronasal fistula was evident.

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"Jabba"; closer view of right oronasal fistula.

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"Jabba"; intra-op view of respiratory track.

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"Jabba"; first layer of a two layer closure
of oronasal fistula.

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"Jabba"; right oronasal fistula closed.
Suture; 4-0 Monocryl.

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"Jabba"; being held during recovery
with "Sebastian helping".

For "Jabba the mutt", a 15mm periodontal pocket at the palatal aspect of the left upper canine confirmed the owner's suspicion of an oronasal fistula on both sides.
Dachshunds frequently develop bilateral oronasal fistulas secondary to periodontal disease.  It is critically important to examine these pets carefully.  When periodontal pockkets are diagnosed early, periodontal therapy can be performed to avoid oronasal fistula formation.  The procedure is called "guided tissue regeneration".

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Dachshund with bilateral (both sides)
oronasal fistulas secondary to canine
teeth extraction.

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Chronic (long term) oronasal fistula
long after a canine tooth was extracted.

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Right oronasal fistula.

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Left oronasal fistula.

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Oronasal fistula closure.
Suture; 4-0 Chromic catgut.

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Left oronasal fistula.

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Right oronasal fistula.

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Right oronasal fistula with respiratory
track discharge and gross contamination.
Photo Credit: Dr. Gary Lantz,
Purdue University.

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Bilateral oronasal fistulas with infected
respiratory track discharge.
Photo Credit: Dr. Gary Lantz
Purdue University.

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All of the premolar teeth were extracted.
Both oronasal fistulas were closed.
Suture; 4-0 Monocryl.
Photo Credit: Dr. Gary Lantz
Purdue University.

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Blackie; 8 yr old chronic oronasal fistula
associated with a previously extracted
canine tooth.  He devloped chronic
respiratory track infections characterized
with draining eyes and nostrils.

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Bloody and purulent (infected) discharge
from the oronasal fistula. 

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A wide based flap was developed to
evaluate the large bony defect in the
maxilla and to repair the oronasal fistula. 
The periodontal probe demonstrated the
soft tissue defect.

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The defect was debrided and closed
using 5-0 Monocryl suture.

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Recovery was very impressive for Blackie!
He would not allow an intraoral photo
however his respiratory track problems
resolved after the oronasal fistula repair.

Clinical case of oroantral fistula


This pet had a large hole (fistula) located between the third and fourth premolars.

 

 

The fistula was repaired.

 



Dr. Kressin has treated oronasal and oroantral fistulas in many cats and dogs.  In cats or dogs with chronic (long term) oronasal fistulas, the repair can be particularly difficult especially when previous surgeries have been performed.  The first attempt to repair these lesions is the best opportunity for success. 

We see many oronasal fistulas especially in the Dachshund and other smaller dog breeds.  In cats with chronic periodontal disease and alveolar osteitis, it can be difficult to closed the canine tooth extraction sites.  Failure to close these sites often results in oronasal fistulation.  Never wait to see if these sites will heal by "granulating in" because they don't.  Earlier attempts to repair these defects offer the best prognosis.  We enjoy working as a team with you, your pets and your primary care veterinarians.

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