I'm headed back to the OS tomorrow...hopefully we can get this figured out. If it continues, I'll inquire with ENT.

Thanks again!

-Rick

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Bryanna
I just had 2 upper molars pulled opposite sides on Friday 3/4/16 and on Sat i noticed air and fluid coming out of my nose went to the periodontist first thing Monday 4/7/16 that put me under and took them out i have a perforated sinus he said he can't repair it till 3/24/16. 2.5 weeks away the pain is bad is this common to wait that long I thought it would be done right away he did put me on Amoxicillin for 7 days i've seen you answer questions on here I have no insurance and little money to just pay to be told the same same thing from another doctor i was hoping i could get a verified time frame to get it fixed (surgery) is a periodontist qualified for this type of thing he made it sound like no big deal thank you Robert s

Hi Rick,

So what did the oral surgeon say?

Drop us a note when you can... thanks!
Bryanna



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Robert,

I answered your inquiry on the other thread where you also posted it.

Bryanna

Hi Bryanna...so here's the latest,

I've been to the VA ENT. They did a CT scan and put me on 1 month (2x day) Amoxicillian. Said I have a deviated septem and will likely do surgery. They saw the soft tissue from the extract but said the septem is more of the problem.

Today I felt a pop sound at the extraction site and puss just started flowing out. I'm guessing this is the same puss the doc showed me on the scan (he compared one side which was black and the other which was white with a little black) Said "black sides matter," not really, ha. He did say the black indicates air and is what the issue side should look like (saw only a small air pocket)

I can now bring in air (communication) from the sinus, not the "water coming through" size, but if I apply suction from the mouth or blow it releases or introduces air. I'm guessing this is bad?

Yikes!

Hope all is well on your end - Rick

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Hi Rick,

Yes, black sides do matter ..... I mean the black on the scan indicates air which is what you want to see pertaining to the sinuses.

The air is a problem as it means the sinus is open someplace. You also have a nasty infection that may not be related at all to your deviated septum but it may be just as, if not more, significant than the septum issue. The oral antibiotic may not work and/or it may not be the appropriate species for the bacteria that is causing the infection. A clean catch specimen of the pus sent to the lab for a culture would determine the proper antibiotic. I would ask the ENT if he can do that. Also if the infection is still present when you have the septum surgery, you could have surgical and/or post op complications due to the unresolved infection. So the infection is an issue.

I'm sorry you are going through all of this....
Bryanna





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Ugh, lol.. I feel like there has always been something "stuck" that kinda kept the sinus closed after the extraction. When I sneezed (a couple days ago), a rice-shaped piece came out along with all the puss. I now have all the advertised sinus communication symptoms "air flow to/from sinus, can't drink with a straw, etc." I'm guessing since it has been so long since the procedure and I have easy air flow, the OS will have to do surgery to close the communication or can it heal on its own? Can the OS capture a culture and determine the correct antibiotic?

ENT may be a bit more time waiting as it's through the Veterans Administration (VA) but I do have an appt in a week.

Thanks again for the input...hope you're having a great Sunday!

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Rick,

Was that "rice" like thing that came out a piece of tooth? Was it hard? Did you save it? I ask because it may be the link to your situation with the infection.

I would consult with the OS and the ENT as to who can do the culture asap. If the proper antibiotic is not taken the infection will not clear and the bacteria will become resistant to that medication and treating it can become more complex. So it is very important to know the proper meds and time is crucial.

You may need surgery to close this perforation and clear the infection for 2 reasons. One is it is long standing, meaning it's been present for at least as long as the tooth was root canaled. Two, it's had time to progress.

I'm not a big fan of the VA healthcare system for a variety of reasons based on my professional experience. They are not usually up on the latest approaches to things, especially in dentistry. Can you see someone who practices privately?

Bryanna



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I didn't save it, but felt it was the "plug" that would occasionally "pop," irritating that area resulting in new sinus infections. I don't think it was part of a tooth, as the tooth I saved shows metal breakage. The OS later did an xray and I assume would have been able to see anything hard-like.

ENT is through the VA who did the CT scan. They didn't say anything about the extraction site other than being able to see a missing tooth (soft tissue). Their focus seemed to be unrelated to the extracted tooth and concluded the deviated septum as the root of the sinus infections.

The VA medical side has been positive from my experience; their process to get things done is more of an issue.

My OS is private practice and did the extraction. I'm assuming he can do the bacteria culture test and the surgery flap? I'm scheduled to see him this week.

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Rick,

It was a foreign matter but could have been tooth or bone related. Sometimes (quite frequently) when a tooth is extracted, a piece of the tooth or a piece of the jaw bone gets splintered or fractured off and it gets pushed during the surgery into a place where it may or may not be seen on an xray or a scan. Depending on where it is, sometimes it will work itself out through the mouth or the nose. The infection however may have progressed beyond the actual site of where the "piece" was pushed to. This could account for chronic sinus infections and the current perforated sinus.

It is imperative that your OS and the ENT collaborate on your case. One should not be doing anything without giving consideration to the problems in their entirety. Meaning, neither issue should be dismissed or overlooked when dealing with the other. The septum issue and the tooth related infection should not be dealt with separately.

The ENT must take into consideration all that has transpired with the extracted root canaled tooth. Beginning with the history of that tooth ... the fact that it was root canal and when ... the problems you had that lead up to the tooth being extracted ... the oral surgery to extract it and what was found during the surgery ... the post operative complications that occurred ... the timing of the sinus infections ... the "rice" like finding ... the pus that extruded ... the abnormal air flow ..... ALL of these things are important notes to be taken into consideration when dealing with your septum if you are to heal properly from that surgery.

The ENT and the OS need to collaborate on your case. You may have to insist upon it because doctors often have egos that get in the way of sharing cases with other doctors. Or they hesitate to make the contact because they know or suspect something has gone amiss with the care and they have to be careful how they approach the case. Either way, those issues are not your problem. Your problem is getting the best and most thorough care possible.

Please consider the information that I have given you seriously. If you have some doubt about the importance of the doctors collaboration ... read through all of Angels31 dental saga here on this forum. She's been through hell because her ENT and OS have yet to collaborate on her dental situation Which by the way with a few minor differences, happens to be very similar to yours.

Bryanna





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