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Old 11-28-2016, 08:20 PM #1
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Default Sinus Perforation?

Hi,

I am a working musician - trombone player and had 3 wisdom teeth removed 10 days ago (upper right, upper and lower left). The wounds seem to be healing nicely. However, I think I have a sinus communication on my upper left extraction wound.

I had been rinsing with salt water a week after the surgery, and also with a waterpik. On the 9th day, water dripped out of my my nose as I was bent over the sink while rinsing. No water goes into my nose if I am standing upright.

My question is: if there is a perforation or communication, can I play my instrument? I've sent an email to my dentist but has yet to hear back from them.

This is a time constraint for me because if I cannot play, I need to find subs for my shows and rehearsals which start in 2 days.

Any help is appreciated!
MJ
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Old 11-28-2016, 09:48 PM #2
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I don't know if you checked any musician websites for this question..
But I think I would have subs on call and ready to go , just in case..
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Old 11-28-2016, 10:22 PM #3
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Hi Jo*mar,

Thanks for your reply. I have found several testimonies of pain and nerve damage (stories far more terrifying that what I am experiencing) but none on my specific condition, which is why I take to asking here. My guess is that I somehow tore the membrane while using the waterpik to clean the wound after a meal
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Old 11-29-2016, 02:40 PM #4
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Hi MJ,

The short answer is you should refrain from playing a horn instrument until the sinus membrane closes over. If you play, the circulation and force of air used to play the instrument will prevent the membrane from closing. An open maxillary sinus membrane can lead to all sorts of sinus problems that can be difficult to remedy.

1) Even though the gum tissue is healing over your surgical wound, the wound is still open for bacteria to enter into it. It only needs to be open a microscopic fraction for bacteria to get in. The tissue is not likely to close tightly if the membrane does not heal.

2) Your sinuses are only inches from your brain. So bacteria that gets trapped beyond the membrane can eventually migrate. It is very important that the membrane close.

A general dentist is not well trained in sinus perforations. It is best to consult with an oral surgeon and the sooner you do this, the better the outcome. You would need your pre op xrays and he would take xrays to view the perforation. He may do some additional tests to help determine the degree of the perforation.

It is best to refrain from using the waterpik. Did your dentist instruct you to use the waterpik or was that something you chose to do on your own? I ask because most dentists would not suggest that.

I would urge you to consult with the oral surgeon as soon as possible and refrain from playing the instrument.
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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 11-29-2016, 04:23 PM #5
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Hi Bryanna,

Thanks for your advice. I heard back from the dental clinic today and am told the oral surgeon (who performed the extractions) will call me by the end of day. She is travelling at the moment and I have made the necessary arrangements for the shows I have to do.

I used the waterpik at my own accord, and am right now quite mad with myself for doing so. Kicking myself hard for this. I had become so paranoid about having food stuck in the wounds because i felt bits in the holes after a meal that I overdid the cleaning. It now seems like there are perforations in both upper left and right extraction sites (though the left feels larger).

I am hoping that the surgeon can have it treated/sealed as soon as possible as I also have to fly on 7 Dec.
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Old 11-29-2016, 07:43 PM #6
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Hi MJ,

You need to have the oral surgeon do an xray and clinical evaluation. She cannot determine anything without doing those things. So if she can not get you in asap, then is it possible to see a different oral surgeon? Flying with a maxillary sinus perforation is not a good idea especially if there is any chance of an infection. Please discuss this in detail with your oral surgeon.

The treatment for a sinus perf depends on the location, size and depth of the perforation and if there is any suspected infection. Sometimes small perfs in healthy sinus will heal on their own. But flying or playing your horn instrument could worsen a small perf. So it's best to have it clinically evaluated asap.

Bryanna


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Hi Bryanna,

Thanks for your advice. I heard back from the dental clinic today and am told the oral surgeon (who performed the extractions) will call me by the end of day. She is travelling at the moment and I have made the necessary arrangements for the shows I have to do.

I used the waterpik at my own accord, and am right now quite mad with myself for doing so. Kicking myself hard for this. I had become so paranoid about having food stuck in the wounds because i felt bits in the holes after a meal that I overdid the cleaning. It now seems like there are perforations in both upper left and right extraction sites (though the left feels larger).

I am hoping that the surgeon can have it treated/sealed as soon as possible as I also have to fly on 7 Dec.
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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 11-29-2016, 10:11 PM #7
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Hi Bryanna,

Thanks for letting me know! I spoke with the oral surgeon who performed the extractions. The earliest appointment I can make with her is well into my travel dates so she has suggested that she does the procedure after I return, which is in January, by which she hopes they might close on their own.

She also said that if the procedure is done before flying the holes might open up again. Instead, she is prescribing an antibiotics refill and another antibiotic specific to sinus infections for me to take (in case I need to) when I am travelling. She has given me her personal number and ask that I get in touch if I have any concerns. But other than that, she said barring playing the trombone, sucking on straws, and vigorous rinsing, I should be able to do everything else normally, including exercise.

I hope she is confident and right in her assessment.
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Old 11-29-2016, 11:24 PM #8
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Hi Bryanna,

My next question is if another surgeon can seal it up before I fly (I have to fly, can't cancel), would that be more preferable to have the hole(s) sealed up before, or leave them as it is as suggested by the current surgeon?

Thank you for being so helpful and patient with my queries. Turns out looking for subs to gigs is the least of this problem.
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Old 11-30-2016, 11:01 AM #9
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Hi MJ,

Here's the problem.... she has no idea how large the openings are so how can she determine if they need intervention before you fly? The prescriptions are not going to help close the perforations. In fact, taking antibiotics that you do not need can cause you to become ill because they severely disrupt the balance of the intestinal bacteria. In many people this could leave them with little to no healthy bacteria which would lead to all sorts of problems. Antibiotics are only intended to be used when necessary.

It is important to have a clinical and radio-graphic evaluation before you fly. She is OBLIGATED to see you and not put this off. If she won't, then it would be wise to consult with a different oral surgeon. However, most surgeons are going to be reluctant to surgically intervene where another surgeon has just performed surgery. She should be getting you in asap for an evaluation, period. She cannot make a determination based on just your symptoms over the phone and giving unnecessary antibiotics is not ethical.

Also, a side note about exercise.... it is not wise to perform any cardio exercise or anything similar that increases your BP or heart rate until the perforations are healed. There is a direct correlation between an elevation in BP and the maxillary sinus. She should have told you about that.

Bryanna



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Originally Posted by musicjay View Post
Hi Bryanna,

My next question is if another surgeon can seal it up before I fly (I have to fly, can't cancel), would that be more preferable to have the hole(s) sealed up before, or leave them as it is as suggested by the current surgeon?

Thank you for being so helpful and patient with my queries. Turns out looking for subs to gigs is the least of this problem.
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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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