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Old 06-16-2015, 07:06 AM #1
ELna ELna is offline
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Default Sinus perforation again

Hi. I have found this site looking for answers - it is amazing. Any information about swelling and what to expect later on would be a great help!

After years of planning on doing it finally had two of my RC teeth extracted on Friday to help my body deal with the aftermaths of Ramsay Hunt Syndrome. Top left and right 7s.
Sinus perforation on both sides, noticed when I came home. Phoned up, dentist said it will heal on its own.
As drink was going into my sinuses I went back next day to see an oral surgeon who said if not closed within 24 hours I will need a major operation in a hospital later on.
He closed both of them but was willing to see another patient before his early evening flight so I heard him telling to the receptionist proudly: this should take 45 minutes each I did 2 in 25 mins.

By the time I was home I could tell the right one was open. Went back two days later, yesterday, and another OS closed it again - he said he has to sacrifice the bone to give the closure a chance.

He (both) also said that there is no chance for this to heal on its own and if it remains or breaks open again, i will need to have a major operation in the hospital in a few weeks time. Is that true?

I am not doing anything for 3-4 days now just let it heal.

Also, my face is really-really swollen since yesterday - he didn`t mention that but that is normal isn`t it? After this latest operation for a couple of days? Otherwise I am in not too much pain.
Taking antibiotics and using nasal spray.

Sorry came out long. Appreciate any thoughts. Thank you so much,
Elna
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Old 06-16-2015, 10:21 AM #2
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Hi Elna,

So glad to hear that you have been reading our posts and have found the information given to be amazing!! We try to be helpful.... but amazing is nice too :> Thank you!

For those reading Elna's post.... Ramsay Hunt Syndrome is a varicella zoster virus, same virus as chicken pox or shingles. But this one affects a nerve in the head specifically a facial nerve near the inner ear. The complications of this virus can be numerous and quite debilitating. If anyone is interested, you can google Ramsay Hunt Syndrome for information.

Elna, when were you first diagnosed with RHS? Has it flared up since the oral surgery? Did you make every dentist that you have seen aware that you have RHS?

Regarding the tooth extractions.... glad to hear that you had the root canaled teeth removed as that is two less burdens on your immune system. Do you have any other root canaled teeth? What is the general health of your other teeth and gums? I ask those questions because your overall oral and dental health can have a profound affect on the healing of these two extractions. I just want you to be aware of that as you may need additional treatment to close the sinus perforations and if there are other oral infections, the healing may be lengthy and/or compromised.

Elna, are you concerned about the dental care that you have been receiving? Is this a clinic type or multi practice office with various types of dentists? If so, is it possible for you to seek private dental care from an oral surgeon? I just feel like you have been handed off from one dentist to another and I am concerned about your future care there, for this problem and any others that you may have. How do you feel about that?

Given the type of surgery you have had and multiple times... the swelling may be quite significant for a few days. However, you should report this to the oral surgeon in case he feels it is more than it should be at this point. You are taking antibiotics, did they also prescribe steroids? Did the oral surgeon prescribe the nasal spray? Is it a prescription spray?

It important that you drink plenty of water throughout the day to stay hydrated and to keep flushing the toxins out of your body. When you drink, is the water still coming out of your nose? Are you able to eat? It is best to stay on a nutritious soft food diet for a few weeks to provide nutrition and give your mouth a rest from a lot of chewing.

Are you doing gentle oral rinses with warm salt water? This will help disinfect the wounds and help heal the tissue. If you are rinsing, is the water coming out of your nose?

Each day you have to be mindful of the changes that are taking place and how you feel overall as this will give you clues as to whether you need to be seen by the surgeon, rather than just wait it out. You may feel lousy for a few days, but things should then start and continue to improve each day.

Hopefully you will heal okay and no more surgery will be needed to repair the sinuses. Please keep in touch with us here.
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 06-16-2015, 01:43 PM #3
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Dear Bryanna,

Thank you so much.
You do know about RHS??

Started last May with 5 months of pain, nausea, balance, total paralysis of the right side of my face and neck, vision problems and a lot of other issues since (post-herpetic neuralgia). As many people with RHS I was misdiagnosed at the beginning.
I was feeling a bit better lately and found l-lysine, that helped a lot. I wanted to help my body further with the extractions. Well...
No flare-up yet, ear-pain a bit worst than normally but I hope it is just because of the teeth. I doubled l-lysine and try to be as calm as possible.

I have one more root canaled tooth left, thankfully it is lower jaw.
Other than that I have good teeth and healthy gums.

Thank you, so should not worry about the swelling too much then for a few days then, I reached the OS today he said it was ok.

No steroids. I will ask about that if the swelling does not subside in 3-4 days?
I was told to buy any nasal spray with Oxymetazoline and use it twice a day.

Not as bad as before but yes, water still goes up a bit.
I can not eat, have been drinking home-made fruit and vegetable juices so far. I figured it lowers the chance for sinus infection as opposed to chicken soup? Maybe does not make any difference.
I was doing oral rinses with salt water then the OS said no need and just rinse and clean with corsodyl 4 times a day. But I prefer salt water.

He said if it will still be open after this second procedure, they will give me a referral to the hospital for surgery.

If the perforation in partially closed by surgery do you think there is any chance that the rest might heal by itself?
If not, can this be fixed by surgery for good? Is this a major issue?

Thank you. I wish there was a field I could help someone with - I`m afraid there ins`t
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Old 06-17-2015, 08:33 AM #4
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Hi ELna,

You are very welcome

Yes, I am familiar although not well versed in RHS. It has also been my experience that people are often misdiagnosed as it mimics many other disorders and although the symptoms are fairly obvious, they differ from one person from another. Yes, the amino acid L-lysine is very good at treating and even preventing/minimizing outbreaks of the virus. Also have you looked into the benefits of eating a diet low in Arginine foods? This too is an amino acid but studies have shown that it may not be tolerated well in people who have this virus and it can actually aggravate the virus.
Here's a link to some friendly and informative info ...
http://www.drdeborahmd.com/solutions...simplex-type-2

The nose spray that you are using with the Oxymetazoline is only meant to be used temporarily, like a few days, because it can actually have a rebound affect and cause congestion, etc. So be mindful of how much you are using it.

I was curious if he prescribed steroids, glad to hear he didn't. They are not without side effects and if possible should be avoided.

Home made veggie and fruit juices are good but it's best to buy fresh organic produce because the contaminated soil and pesticide residue with non organic is not going to do you much good. If you make home made soups, the health benefits are unmeasurable. So don't be hesitant to do that.

Yea, I am also a big proponent of salt water rinsing over chemical laden ones. The chemical ones kill all of the bacteria, both good and bad which makes no sense because you need to keep the good for healing purposes. Generally the chemical mouthwashes are prescribed because many people have less than ideal oral hygiene habits. But if you keep your mouth clean, brush and floss thoroughly every day, and eat a nutritious diet you can just use the salt water to rinse with.

The sinus perforation may close on it's own. It really depends on why it occurred in the first place and if there is ongoing pathology still present. The surgery to close the perforation depends on the location, severity and reason it's there. Those reasons also determine if it ends up being a chronic problem or not. So hopefully yours will heal on their own over time and not have to ever be dealt with again.

How are you feeling today? Is the sinus issue less than yesterday?
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 06-17-2015, 05:45 PM #5
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Dear Bryanna,

Thank you again. And for the information on RHS too!!
A perforation may close on its own - thank you for that. HOPE - really needed some, I am not ready to think of another operation just yet.

About the steroids :-): I admit now that would not have taken them just yet even if he subscribed them - I think some of my present problems are still due to the steroids taken for RHS earlier.

Prior to the extractions I had no pain, no symptoms of any oral disease. I use a water flosser, electric and normal toothbrush - well, not at the moment.
It was a difficult extraction - both lasted about 30 mins, taken out root by root. On the now more effected side a piece of the root broke in and she removed it which took further 15 mins. But no clue on the other side. Maybe the roots were too deep in.

Can I ask one more please?

As you wrote the nose spray can only be used for a few days, is there anything else you think I could do to minimize the chances of a sinus-infection while the perforations (maybe) heal? What is your opinion on Sudafed capsules?

Thank you very much. Hope you are well :-)
ELna
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Old 06-17-2015, 07:09 PM #6
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Would you be so kind to have a look at my pre-op x-ray please? Besides the one remaining root canaled at the bottom do you see anything worrying, a possible source of my health problems? I am so sorry, it is just that you seem to know more than my gp, neurologist and dentist together. Thank you again and again.
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Old 06-17-2015, 07:36 PM #7
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Hi ELna,

Yea I kind of thought you had been on steroids for the RHS as that is often prescribed for that virus. Steroids are often given out like candy and the long term effects of taking them can be difficult. I think people should be forewarned about that too!

The nasal spray is used to keep the sinus clear of dust, debris and congestion. An oral pill will reduce inflammation and congestion but that's it. I cannot tell you what else to use, only the OS can do that. But perhaps you could ask him about using just saline nasal spray because it serves the same purpose as the other spray, without the chemicals, and there is no worry of dependency or rebound affect.

How are the swelling and sinus issues today?
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 06-18-2015, 10:27 AM #8
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Dear Bryanna,

Thank you for the advise - I'll ask about the saline spray!
This morning I woke up for the sound of air running through my face somewhere, slowly, for a good 10-15 seconds. I decided to take it as a good news. If the air travelled so slow then there might be a hole much smaller than before... but where was it?
Swelling is somewhat better, there is a pressure in face, front, head in general - this makes me feel rather worst than better.
Started using a bioptron lamp, hope it helps.
I'll be patient until Monday and then I'll have the right to return to utter despair. :-)
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Old 06-18-2015, 11:51 AM #9
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Hi ELna,

I just saw the xray now, thanks for posting it! Has your dentist informed you of any other areas of concern? I see a few, do you want me to tell you what they are?

Regarding the two upper rc molars.... both of them had sinus communication and it appears likely that the infection had entered the sinus on both sides. So the dentist who removed them knew he was going to be in the sinus just based on this radio graph.

I don't know how you copied this xray, face down or not, so I don't know which is your left or right. However, looking at this photo on the left side of this xray, the infection from the rc molar appears to have spread quite far into the sinus and the health of the first molar may be in jeopardy from the infection and there appears to be some deterioration of the root structure of this molar tooth. This could be one reason why you are having so many post op complications. If that tooth is infected, it could prevent the sinus from closing. Has your dentist talked to you about this molar tooth?
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 06-18-2015, 11:57 AM #10
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ELna,

That sound of air running through your face does not sound normal. Do you mean you could feel air circulating from your sinus on one side and then to the other?

It would be normal for there to be swelling upon awakening if you have had your head down for several hours. But that swelling should be reducing as the day goes on and with each day the overall swelling should be less and less. Do you feel that is happening?

How does it feel, look after the light therapy?
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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