ISSN 2398-2950      

Oronasal fistula

ffelis

Synonym(s): Cleft palate, secondary cleft


Introduction

  • Cause: oronasal fistula is a congenital or acquired communication between the oral and nasal cavities.
  • Congenital fistulae may be caused by numerous etiological agents acting at the appropriate susceptible stage of gestation. Additional associated abnormalities, eg harelip may also be present.
  • Acquired fistulae are caused by trauma or disease.
  • Signs: relate to the oral and nasal cavities, and sometimes to the chest if secondary pneumonia is present.
  • Diagnosis: usually straightforward, based on history and clinical signs.
  • Treatment: reconstructive surgery.
  • Prognosis: generally favorable, although euthanasia of congenitally affected neonates is often performed.

Pathogenesis

Etiology

  • For congenital fistulae, the following are possible etiologies:
    • Inheritance: incomplete dominant, recessive or polygenic traits.
    • Infectious disease: bacterial, viral.
    • Nutritional factors.
    • Mechanical factors: uterine crowding, uterine trauma.
    • Toxic factors.
    • Hormonal factors.
  • It may not be possible to determine the precise cause of congenital fistulae.
  • Common causes of acquired fistulae are:

Pathophysiology

  • Multiple etiologies for congenital fistulae.
  • The etiological agent must act at the appropriate stage of fetal development when the palate is developing and closing.
  • Acquired fistulae are associated with
    • Degenerative, eg oral infection).
    • Infiltrative, eg oral neoplasia disease.
    • Direct trauma.

Acquired fistulae

  • Most common scenario is progressive dental disease resulting in lysis of the thin alveolar bone plate at the apex of the alveolus. Communication is then established between the oral cavity and the nasal cavity/maxillary sinus.
  • Traumatic dental extraction techniques Dental extraction can result in disruption of the thin alveolar bone, which may already be devitalized.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Smith M M & Rockhill A D (1996) Prosthodontic appliance for repairs of an oronasal fistula in a cat. JAVMA 208 (9), 1410-1412 PubMed.
  • Marretta S M (1992) Chronis rhinitis and dental disease. Vet Clin North Am Small Anim Pract 22 (5), 1101-1117 PubMed.
  • Salisbury S K & Richardson D C (1985) Partial maxillectomy for oronasal fistula repair in the dog. JAAHA 22 (2), 185-192 VetMedResource.

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