Dec 14

December 2015 – Oranasal Fistula

This 12 year old MN Bloodhound presented for evaluation of a right sided oronasal fistula (ONF). The patient had the right maxillary canine tooth extracted years earlier and subsequently developed an ONF. He had the ONF repaired a short time thereafter, but the procedure was unsuccessful. The patient has been living with a chronic ONF for years. Below is the gross appearance of the right maxilla.

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What recommendation would you make to the owner for this patient? What single diagnostic is absolutely essential in a case like this?

The most important diagnostic for this patient was dental radiographs. Despite several prior dental procedures, he never had dental radiographs. Below is a left maxillary dental radiograph.

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As you can see, there is a root tip of the right maxillary canine tooth. A large gingival flap was created, the root tip was identified and removed and all granulation tissue was debrided from the ONF.

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A bone grafting material called Ossiflex (Veterinary Transplant Services) was utilized to cover the ONF and the gingival flap was sutured using 4-0 Monocryl in a simple interrupted pattern. A post operative dental radiograph was taken and therapeutic k-laser was utilized while the patient was anesthetized to stimulate healing.

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The patient also returned for a series of k-laser treatments throughout the healing period. At the 2 week post surgery recheck appointment the patient had completely healed and was feeling great

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