Przetoka ustno-zatokowa polega na wytworzeniu połączenia pomiędzy jamą ustną a zatoką szczękową. Schorzenie to może stanowić powikłanie leczenia dentystycznego. W przypadku niewdrożenia odpowiedniej terapii przetoka ustno-zatokowa może spowodować groźne dla zdrowia pacjenta powikłania.
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Przetoki ustno-zatokowe powstają w wyniku zabiegów chirurgicznych w obrębie jamy ustnej, takich jak usunięcie górnych zębów trzonowych lub przedtrzonowych, dłutowanie korzeni, resekcja wierzchołków korzeni, usuwanie torbieli i innych zmian w obrębie kości szczęki. Przetoka może również powstać jako następstwo procesów chorobowych powodujących erozję tkanki kostnej oddzielającej zębodoły od zatoki szczękowej (m.in. zapalenie ozębnej, zapalenie kości).
Do wytworzenia przetoki może dojść zwłaszcza u pacjentów, u których warstwa tkanki kostnej, która oddziela korzenie górnych zębów trzonowych i przedtrzonowych od zatok szczękowych, jest bardzo cienka. Zdarzają się także przypadki, w których wierzchołki korzeni są oddzielone od zatoki wyłącznie śluzówką. W takiej sytuacji korzenie zęba mogą bezpośrednio wpuklać się do zatoki szczękowej, przez co w wyniku ekstrakcji zęba dochodzi do powstania niefizjologicznego połączenia między jamą ustną a zatoką szczękową.
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Bezpośrednio po zabiegu ekstrakcji zęba lekarz powinien wykonać próbę, która wykaże, czy doszło do wytworzenia przetoki ustno-zatokowej. Próba jest wykonywana w następujący sposób: przy zamkniętych skrzydełkach nosa pacjent powinien spróbować wydmuchać powietrze przez nos. Jeżeli w trakcie zabiegu powstała przetoka, wydmuchiwane powietrze będzie się przez nią przedostawać. Ponadto przy płukaniu jamy ustnej przez pacjenta płyny będą się wydobywały przez nos.
Leczenie przetoki ustno-zatokowej
Leczenie przetok ustno-zatokowych odbywa się w większości przypadków w warunkach szpitalnych, na oddziale laryngologicznym lub na oddziale chirurgii szczękowo-twarzowej. Terapia polega na zamknięciu połączenia pomiędzy jamą ustną a zatoką za pomocą płata śluzówkowo-okostnowego i zaszyciu zębodołu, w którym powstała przetoka. Co istotne, zabieg powinien zostać wykonany jak najszybciej po stwierdzeniu wystąpienia przetoki. Ponadto powinna zostać wdrożona antybiotykoterapia okołozabiegowa.
Powikłania przetoki ustno-zatokowej
W przypadku braku odpowiedniego leczenia przetoki ustno-zatokowej może ona doprowadzić do wystąpienia przewlekłego zapalenia zatok, a także do zapalenia opon mózgowych, ropnia mózgu oraz zakrzepowego zapalenia zatoki jamistej.
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