{"id":5678045,"date":"2021-03-10T23:37:57","date_gmt":"2021-03-10T22:37:57","guid":{"rendered":"https:\/\/www.dr-delagranda.com\/communication-bucco-sinusienne\/"},"modified":"2024-02-22T08:54:31","modified_gmt":"2024-02-22T07:54:31","slug":"oral-sinus-communications","status":"publish","type":"page","link":"https:\/\/www.dr-delagranda.com\/en\/oral-sinus-communications\/","title":{"rendered":"Oral-sinus communications"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; css=&#8221;.vc_custom_1621611707042{padding-top: 35vh !important;padding-bottom: 25vh !important;background-image: url(https:\/\/www.dr-delagranda.com\/wp-content\/uploads\/2021\/05\/communication-bucco-sinusienne.jpg?id=5676242) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221;][vc_column offset=&#8221;vc_col-lg-offset-1 vc_col-lg-10 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243; css=&#8221;.vc_custom_1603286580076{padding-right: 12% !important;padding-left: 12% !important;}&#8221;]<div class=\"norebro-heading-sc heading text-shadow text-center\"\n\tid=\"norebro-custom-69f17d9588eb7\" \n\t \n\t>\n\t\n\t\n\t\n\t<h1 class=\"title\">\n\t\tOral-sinus communications\t<\/h1>\n\n\t\n\t\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1619517744409{padding-top: 8vh !important;}&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d9589231\" \n\t \n\t>\n\n\t<p>Bucco-sinusal communication (BCS) is the abnormal continuity between the maxillary sinus and the oral cavity, to be distinguished from the communication between the nasal cavity and the oral cavity (nasosinusal communication). Most of the time, this communication can close on its own, but if it persists, a fistula is created, leading to surgery to close it.<\/p>\n<p>Find out more about bucco-sinusal communication from Dr Delagranda, ENT surgeon at La Roche-sur-Yon in the Vend\u00e9e.<\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1619600626772{padding-top: 6vh !important;padding-bottom: 8vh !important;}&#8221;][vc_column width=&#8221;2\/3&#8243; offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-offset-1 vc_col-xs-10&#8243; css=&#8221;.vc_custom_1619534081562{border-top-width: 1px !important;border-right-width: 1px !important;border-bottom-width: 1px !important;border-left-width: 1px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #f9f9f9 !important;border-left-color: #0a0a0a !important;border-left-style: dotted !important;border-right-color: #0a0a0a !important;border-right-style: dotted !important;border-top-color: #0a0a0a !important;border-top-style: dotted !important;border-bottom-color: #0a0a0a !important;border-bottom-style: dotted !important;border-radius: 1px !important;}&#8221;]<div class=\"norebro-text-sc \" \n\tid=\"norebro-custom-69f17d9589526\" \n\t \n\t>\n\n\t<div id=\"post-link-5678045\" class=\"sh-link post-link sh-hide\"><a href=\"#\" onclick=\"showhide_toggle('post', 5678045, 'SOMMAIRE', 'SOMMAIRE'); return false;\" aria-expanded=\"false\"><span id=\"post-toggle-5678045\">SOMMAIRE<\/span><\/a><\/div><div id=\"post-content-5678045\" class=\"sh-content post-content sh-hide\" style=\"display: none;\"><\/p>\n<ul>\n<li><a href=\"#communication-bucco-sinusienne\">Mouth, maxillary sinus and bucco-sinus communication<\/a><\/li>\n<li><a href=\"#causes\">Who needs to have an oral sinus cavity closed?<\/a><\/li>\n<li><a href=\"#indications\">When should an oral sinus defect be closed?<\/a><\/li>\n<li><a href=\"#intervention\">Objectives of buccosinusal communication closure surgery<\/a><\/li>\n<li><a href=\"#intervention\">The surgical procedure<\/a><\/li>\n<li><a href=\"#intervention\">Post-operative recovery period<\/a><\/li>\n<li><a href=\"#complications\">Complications associated with buccosinusal communication closure surgery<\/a><\/li>\n<li><a href=\"#questions\">Frequently asked questions<\/a><\/li>\n<li><a href=\"#rdv\">Appointment<\/a><\/li>\n<\/ul>\n<p><\/div>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621519029615{padding-top: 8vh !important;padding-bottom: 8vh !important;}&#8221; el_id=&#8221;communication-bucco-sinusienne&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d9589756\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tMouth, maxillary sinus and bucco-sinus communication (BCS)\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d95897f9\" \n\t \n\t>\n\n\t<p><strong>Maxillary sinus:<\/strong> this is a pneumatized cavity (filled with air from the nasal cavities) in the maxillary bone, present from birth unlike other sinuses, which grows until the age of 15, in the shape of a pyramid with a lateral tip. An incomplete septum may be present in the maxillary sinus in 2.4% of cases. The maxillary sinus communicates with the nasal cavity via its natural drainage orifice or ostium, located at the level of the intersinonasal septum. The maxillary bone alone forms all the walls of the maxillary sinus, except for the intersinonasal septum, which it shares with the inferior turbinate, ethmoidal bone, palatine bone and lacrimal bone. The floor of the maxillary sinus forms the upper gum bone.<\/p>\n<p><strong>Sinus teeth:<\/strong> Sinus teeth are the upper premolars and molars, because their roots are implanted in the maxillary bone and may be in close contact with the maxillary sinus cavities, or even entirely in the sinus (antrals).<\/p>\n<p><strong>Bucco-sinusal communication:<\/strong> Bucco-sinusal communication (BSC) is the abnormal communication between a maxillary sinus and the oral cavity.<\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621519043290{padding-top: 8vh !important;padding-bottom: 8vh !important;background-color: #0f2233 !important;}&#8221; el_id=&#8221;causes&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d9589865\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tCauses of buccosinusal communication\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d95898f9\" \n\t \n\t>\n\n\t<p><strong>The main cause of a BCS is a surgical procedure<\/strong> (iatrogenic cause = due to the action of a doctor\/surgeon\/dentist):<\/p>\n<ul>\n<li>Avulsion of a maxillary tooth. This happens most frequently with the avulsion of maxillary molars, as these teeth are often close to the maxillary sinus, or even antral, with roots entirely within the sinus.<\/li>\n<li>Any surgical procedure involving the maxillary sinuses: maxillary bone cyst removal, orthognathic surgery, pre-implant surgery (sinus floor elevation), dental apex surgery (apical resection), removal of cancer, benign tumors (osteomas).<\/li>\n<\/ul>\n<p><strong>The cause may also be medical<\/strong> (iatrogenic = due to the action of a physician):<\/p>\n<ul>\n<li>Following external cervico-facial radiotherapy: radiation can weaken bone by reducing vascularization (ischemia) and regeneration potential. This is known as osteoradionecrosis. Generally speaking, however, osteoradionecrosis is the result of bone surgery on a bone that has withstood irradiation, and will therefore not appear spontaneously.<\/li>\n<li>Osteoporosis is caused by antiresorptive drugs used to prevent bone resorption and remodelling in cancer: biphosphonates, anti-RANK-Ligand antibodies (denosumab), anti-angiogenic antibodies (sunitinib, bevacizumab), m-TOR inhibitors (rapamycin, everolimus, temsirolimus). This is known as osteochimionecrosis.<\/li>\n<\/ul>\n<p><strong>The cause can also be traumatic:<\/strong><\/p>\n<ul>\n<li>Accidental loss of maxillary bone substance (road accident, sports accident, suicide attempt with firearms).<\/li>\n<\/ul>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row&#8221; css=&#8221;.vc_custom_1621611886544{background: #ffffff url(https:\/\/www.dr-delagranda.com\/wp-content\/uploads\/2021\/05\/communication-bucco-sinusienne-et-racine.jpg?id=5676244) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; el_id=&#8221;indications&#8221;][vc_column][vc_empty_space height=&#8221;120px&#8221;][vc_row_inner][vc_column_inner width=&#8221;7\/12&#8243; css=&#8221;.vc_custom_1607095018746{padding-right: 10% !important;padding-left: 10% !important;background-color: rgba(255,255,255,0.95) !important;*background-color: rgb(255,255,255) !important;}&#8221;][vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f17d958995f\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tWhen should a bucco-sinusal closure be performed?\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d95899de\" \n\t \n\t>\n\n\t<p>Bucco-sinusal communication closure mostly concern adults with a hole in the upper gum communicating with the sinus. Children are exceptionally concerned.<\/p>\n<p>A bucco-sinusal communication closure should be performed in cases of :<\/p>\n<ul>\n<li>Persistent sensation of air passing into the mouth through a hole in the upper gum.<\/li>\n<li>Persistent leakage of thick liquid into the mouth through a hole in the upper gum.<\/li>\n<li>Passage of liquid food from the mouth to the nose via the maxillary sinus.<\/li>\n<li>Repeated unilateral maxillary sinusitis.<\/li>\n<li>Voice changes.<\/li>\n<li>Repeated bleeding into the mouth or nose (epistaxis)<\/li>\n<\/ul>\n\t\n<\/div>[vc_empty_space height=&#8221;80px&#8221;][\/vc_column_inner][vc_column_inner width=&#8221;5\/12&#8243;][\/vc_column_inner][\/vc_row_inner][vc_empty_space height=&#8221;120px&#8221;][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621519059223{padding-top: 8vh !important;padding-bottom: 8vh !important;}&#8221; el_id=&#8221;intervention&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d9589a4f\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tSurgery and post-operative care\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f17d9589abe\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tObjectives of bucco-sinusal communication closure?\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d9589b31\" \n\t \n\t>\n\n\t<ul>\n<li>Stop the passage of fluid and food debris from the mouth to the maxillary sinus.<\/li>\n<li>Stop direct drainage from the maxillary sinus into the mouth.<\/li>\n<li>Stop repeated bleeding into the mouth or nose.<\/li>\n<\/ul>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f17d9589b8c\" \n\t \n\t>\n\t\n\t\n\t\n\t<h3 class=\"title\">\n\t\tSurgical procedures\t<\/h3>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d9589c08\" \n\t \n\t>\n\n\t<p>The procedure is performed under local or general anaesthetic, depending on the location and size of the BCS. The patient&#8217;s medical history may influence the choice of technique and whether or not general anesthesia is required.<br \/>\nSurgery is strictly endo buccal, with no scars on the face. Several surgical solutions are possible, depending on the situation:<\/p>\n<ul>\n<li><strong>BCS post immediate or recent avulsion:<\/strong> Small extent (&lt;5 mm): direct closure-stitches. Larger extent (&gt;5 mm): cheek (vestibular) or palate (fibropalatine) mucosal flap.<\/li>\n<li><strong>Chronic BCS:<\/strong> Small extent (&lt;5 mm): Direct closure-suture using single-stitches, but with edge swelling to facilitate edge adhesion, and removal of necrotic bone. Larger (&gt; 5 mm) and predominantly anterior: Cheek (vestibular) or palate (fibropalatine) mucosa flap.<\/li>\n<li><strong>Greater extent (&gt; 5 mm) and predominantly posterior:<\/strong> pedicled flap of the jugal fat body, known as Bichat&#8217;s ball, and in extreme cases a bone graft, bio-material, free flap or obturator prosthesis.<\/li>\n<\/ul>\n<p>The surgeon may or may not decide to combine this procedure with a complementary one, which is indicated in some situations and consists of draining the affected maxillary sinus, either endonasally or via a meatotomy.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-heading-sc heading text-left\"\n\tid=\"norebro-custom-69f17d9589c62\" \n\t \n\t>\n\t\n\t\n\t\n\t<h3 class=\"title\">\n\t\tPost-surgery recovery period\t<\/h3>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d9589cd1\" \n\t \n\t>\n\n\t<p>In the case of outpatient surgery, the patient usually returns home the same day.<br \/>\nAfter hospitalization, you should remain at home for 8-10 days, resting and checking for nose and throat bleeding.<br \/>\nFood should be soft, cold and preferably chewed on the other side for 8 days.<br \/>\nAvoid hard, pungent or offensive foods.<br \/>\nThe surgeon will give you a 7-day leave of absence from work if necessary.<br \/>\nSport is not recommended for the first 2 days.<br \/>\nDo not blow your nose strongly for 15 days, as this may cause the BCS to reopen.<br \/>\nRigorous oral hygiene is essential for a successful operation.<br \/>\nDo not smoke during the healing period, as there is a risk of recurrence, necrosis and superinfection in the operated area.<br \/>\nMeals should be taken slowly to avoid untimely biting of the flap.<br \/>\nPain is moderate. Class I analgesics are used to control pain.<\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621519067188{padding-top: 8vh !important;padding-bottom: 8vh !important;background-color: #0f2233 !important;}&#8221; el_id=&#8221;complications&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d9589d2b\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tComplications associated with surgical closure of bucco-sinusal communication (BCS)\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d9589da4\" \n\t \n\t>\n\n\t<p>In addition to the risks inherent in any surgery involving general anaesthesia, CBS closure presents rare complications:<\/p>\n<ul>\n<li>Nasal haemorrhage (epistaxis) after the procedure, which is very minor and rapidly subsides with nose-blowing and nose-washing.<\/li>\n<li>Oral hemorrhage.<\/li>\n<li>Infection of the surgical site in the mouth and\/or maxillary sinusitis<\/li>\n<\/ul>\n<p>Reopening of the BCS is not a complication but rather a failure. A new attempt is necessary.<\/p>\n<p>Please refer to the ENT College&#8217;s explanatory sheet on suspension laryngoscopy for further explanations:<\/p>\n<p><a href=\"https:\/\/www.dr-delagranda.com\/wp-content\/uploads\/2021\/05\/fiche-orl-communication-bucco-sinusienne.pdf\" target=\"_blank\" rel=\"noopener\">\u2794 Communication bucco-sinusienne<\/a><\/p>\n\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content&#8221; css=&#8221;.vc_custom_1621519074528{padding-top: 8vh !important;padding-bottom: 10vh !important;}&#8221; el_id=&#8221;questions&#8221;][vc_column offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10 vc_col-sm-offset-0 vc_col-xs-12&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d9589dfc\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tFrequently asked questions\t<\/h2>\n\n\t\t\t<div class=\"divider\"><\/div>\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d9589e62\" \n\t \n\t>\n\n\t<p>Here is a selection of questions frequently asked by Dr Delagranda&#8217;s patients during consultations for oral-sinus communication closures in La Roche-sur-Yon.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-accordion-s\u0441 accordion-box  outline\" \n\tid=\"norebro-custom-69f17d9589eb3\"\n\tdata-norebro-accordion=\"0\"\n\t \n\t>\n\n\t<div id=\"1605017264328-06613f59-3c90\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Is surgery compulsory?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>No, but it is strongly recommended to avoid sinusitis and improve living comfort.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1605017264387-ae52c0b0-c778\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Is the result immediate?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>No, you need to wait several days to be sure you&#8217;ve closed the hole.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1605017264450-ed4b6523-622c\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>What precautions should I take immediately after the procedure?<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>Avoid smoking, use mouthwash, eat soft, lukewarm food slowly, and limit chewing on the operated side.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div><div id=\"1605017264576-d1a35267-9612\" class=\"item justify\">\n\t\n\t<div class=\"title\">\n\t\t\t\t<h4>Fees and coverage of the procedure<\/h4>\n\t\t<div class=\"control\">\n\t\t\t<span class=\"ion-plus\"><\/span>\n\t\t<\/div>\n\t<\/div>\n\n\t<div class=\"content\">\n\t\t<div class=\"wrap\">\n\t\t\t<p>Closure of bucco-sinusal communication is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.<\/p>\n\t\t<\/div>\n\t<\/div>\n\n<\/div>\t\n<\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; css=&#8221;.vc_custom_1621519079992{background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; el_id=&#8221;rdv&#8221;][vc_column parallax=&#8221;content-moving&#8221; parallax_image=&#8221;5676558&#8243; css=&#8221;.vc_custom_1622240939856{padding-top: 20vh !important;padding-bottom: 20vh !important;}&#8221;][vc_row_inner][vc_column_inner css=&#8221;.vc_custom_1619469911864{padding-right: 7% !important;padding-left: 7% !important;}&#8221; offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d958a6d7\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tDo you have a question? Need more information?\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d958a749\" \n\t \n\t>\n\n\t<p>Dr Antoine Delagranda will be happy to answer any questions you may have about the closure of bucco-sinusal communication. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vend\u00e9e.<\/p>\n\t\n<\/div>[vc_empty_space height=&#8221;60px&#8221;]<div class=\"norebro-button-sc btn-wrap text-center\" \n\tid=\"norebro-custom-69f17d958a7c4\"\n\t \n\t>\n\n\t<a href=\"#consultation\" \n\t\tclass=\"btn  btn-outline btn-large\">\n\n\t\t\n\t\t\n\t\t<span class=\"text\">\n\t\t\tBook an appointment\t\t<\/span>\n\n\t\t\n\t\t\n\t\t\t<\/a>\n\n<\/div>[\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; el_id=&#8221;consultation&#8221;][vc_column offset=&#8221;vc_col-lg-offset-0 vc_col-lg-12 vc_col-md-offset-0 vc_col-md-12 vc_col-sm-offset-0 vc_col-xs-12&#8243;][vc_row_inner css=&#8221;.vc_custom_1619533987520{padding-top: 8vh !important;padding-bottom: 6vh !important;}&#8221;][vc_column_inner offset=&#8221;vc_col-lg-offset-2 vc_col-lg-8 vc_col-md-offset-1 vc_col-md-10&#8243;]<div class=\"norebro-heading-sc heading text-center\"\n\tid=\"norebro-custom-69f17d958ab45\" \n\t \n\t>\n\t\n\t\n\t\n\t<h2 class=\"title\">\n\t\tENT consultation for closure of bucco-sinusal communication in Vend\u00e9e\t<\/h2>\n\n\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;40px&#8221;]<div class=\"norebro-text-sc justify\" \n\tid=\"norebro-custom-69f17d958abc3\" \n\t \n\t>\n\n\t<p style=\"text-align: center;\">Dr Antoine Delagranda will be happy to answer any questions you may have about the closure of bucco-sinusal communication. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vend\u00e9e.<\/p>\n\t\n<\/div>[\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; gap=&#8221;30&#8243; equal_height=&#8221;yes&#8221; el_class=&#8221;upper-layer&#8221; css=&#8221;.vc_custom_1637759318639{padding-right: 10% !important;padding-bottom: 8vh !important;padding-left: 10% !important;}&#8221;][vc_column width=&#8221;1\/3&#8243;][vc_row_inner css=&#8221;.vc_custom_1502457070774{margin-right: 0px !important;margin-left: 0px !important;background-color: #f9f9f9 !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1607088904656{background-color: #f7f7f7 !important;}&#8221;][vc_empty_space height=&#8221;50px&#8221;]<div class=\"norebro-icon-box-sc icon-box text-`{`object Object`}`\" \n\tid=\"norebro-custom-69f17d958ac3e\" \n\t \n\t>\n\n\t<div class=\"icon-wrap shape-fill brand-bg-color shape-rounded\">\n\t\t\t\t\t<span class=\"linea-basic-geolocalize-01\"><\/span>\n\t\t\t<\/div>\n\n\t<div class=\"content-wrap\">\n\n\t\t<div class=\"content-center with-full\">\n\t\t\t<div class=\"wrap\">\n\t\t\t\t<h3>Cabinet de consultation<\/h3>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\t<\/div>\n\t\t\n\t\t<p class=\"description content-full\">\n\t\t\tClinique Saint Charles<br \/>\n11 boulevard Ren\u00e9 Levesque<br \/>\n85016 La Roche-sur-Yon<br \/>\nVend\u00e9e\t\t<\/p>\n\n\t\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][\/vc_column_inner][\/vc_row_inner][vc_empty_space height=&#8221;10px&#8221;][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_row_inner css=&#8221;.vc_custom_1502457070774{margin-right: 0px !important;margin-left: 0px !important;background-color: #f9f9f9 !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1607088917620{background-color: #f7f7f7 !important;}&#8221;][vc_empty_space height=&#8221;50px&#8221;]<div class=\"norebro-icon-box-sc icon-box text-`{`object Object`}`\" \n\tid=\"norebro-custom-69f17d958afb3\" \n\t \n\t>\n\n\t<div class=\"icon-wrap shape-fill brand-bg-color shape-rounded\">\n\t\t\t\t\t<span class=\"linea-basic-calendar\"><\/span>\n\t\t\t<\/div>\n\n\t<div class=\"content-wrap\">\n\n\t\t<div class=\"content-center with-full\">\n\t\t\t<div class=\"wrap\">\n\t\t\t\t<h3>Prise RDV secretariat<\/h3>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\t<\/div>\n\t\t\n\t\t<p class=\"description content-full\">\n\t\t\t02 51 44 44 85<br \/>\nLundi au vendredi<br \/>\n9h-12h \/ 14h-18h\t\t<\/p>\n\n\t\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][vc_empty_space height=&#8221;25px&#8221; el_class=&#8221;vc_hidden-sm vc_hidden-xs&#8221;][\/vc_column_inner][\/vc_row_inner][vc_empty_space height=&#8221;20px&#8221;][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_row_inner css=&#8221;.vc_custom_1502457070774{margin-right: 0px !important;margin-left: 0px !important;background-color: #f9f9f9 !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1607088929872{background-color: #f7f7f7 !important;}&#8221;][vc_empty_space height=&#8221;50px&#8221;]<div class=\"norebro-icon-box-sc icon-box text-`{`object Object`}`\" \n\tid=\"norebro-custom-69f17d958b03f\" \n\t \n\t>\n\n\t<div class=\"icon-wrap shape-fill brand-bg-color shape-rounded\">\n\t\t\t\t\t<span class=\"linea-basic-clock\"><\/span>\n\t\t\t<\/div>\n\n\t<div class=\"content-wrap\">\n\n\t\t<div class=\"content-center with-full\">\n\t\t\t<div class=\"wrap\">\n\t\t\t\t<h3>Horaires ouverture<\/h3>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t\t<\/div>\n\t\t\n\t\t<p class=\"description content-full\">\n\t\t\tAccueil Clinique<br \/>\nLundi au vendredi<br \/>\n8h-12h30 \/ 13h30-18h30<br \/>\nFerm\u00e9 : sam \/ dim\t\t<\/p>\n\n\t\t\n\t\t\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][\/vc_column_inner][\/vc_row_inner][vc_empty_space 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