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Perforated sinus?
Hi...I had 4 teeth extracted yesterday. One of them, #2, had roots very close to my sinuses, which I'd known ahead of time. Afterward, I was told by the Dr that he'd packed (I could be using the wrong word) it with something extra/different to defend against the chance of infection (or something to that effect, I'm sorry if I'm not remembering it correctly) as well as a prescription for clindamycin. Fast forward to about a half hour ago. I felt and tasted a salty fluid-like....fluid? dripping from the extraction site. I searched and found this site, and what I read led me to think I may have a perforated sinus. I saw some of the symptoms here, but wanted to describe what else I felt before jumping to conclusions, because I didn't read anything about the other things I'm experiencing. The other 3 were all on the left side of my mouth. There's no pain whatsoever on that side. The extraction site of #2 is painless as well. However, there's a strong amount of pressure in my sinuses on that side, which I'd originally chalked up to swelling due on account of how the Motrin works really well for it, and the propoxyphene doesn't. Even that isn't so much painful as annoying. Also, and I'm not really sure how to describe this accurately, but I'll try. When I swallow, and when I tried to smoke, it felt/feels sort of like...like it's pulling or suctioning mucous towards (but important to note NOT OUT, just towards and needless to say I thought I should wait a little longer before trying to smoke again) the extraction. Sort of like (I'm sory for the graphic visual I'm about to cause) like feeling you get when one side of nose is stuffed and you roll over and it drains to the other side. I hope this made enough sense. Oh, and while I have the salty taste, I do NOT have liquids coming back out my nose when I drink. Hope that's enough info to get an opinion. Also, whether it is or isn't a perforated sinus, do I need to be seen ASAP? Can I wait til Mon to call my Dr? Can I just wait til my follow-up appt Fri? Thanks in advance! Sorry for the length, and again, sorry for the bit of grossness I felt it necessary to include.
~Rachel |
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Hi Rai,
Yes, it does sound like you have a sinus perforation. The description of "tears" is right on. Fluid from the sinuses is salty, just like tears. Your description of the sensation that you have when you swallow also indicates a sinus perf. Stop smoking. The sucking action on the cigarette may have opened up the sinus that was being held closed by the collagen plug and suture. It is wise to call the dentist on monday and tell them what has happened as he may want to see you tomorrow. If you continue to smoke, the sinus membrane will not heal closed and you will end up with post operative complications and infections that are very difficult to remedy. It's good that you are concerned about this and should not wait to seek attention for it. Let us know how you're doing... Bryanna Quote:
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Perforated sinus
I have the symptoms of a perforated sinus. I have air leaking out into the mouth. I also have the salty discharge leaking from the extraction site. It's been two weeks since the extraction of tooth #16. The salty discharge has just started to be somewhat less than it had been. I see the oral surgeon today. Do you think a surgical repair needs to be done at this point, or could the extraction hole still close on its own? Normally my gum tissue heals really fast, so I'm concerned about the hole still being open. Also, should the sinus be stitched or patched at this point?
Also, I am supposed to fly out of town next Friday. I would not want to go if this could cause a problem with a sinus infection or tearing the perforation further. What do you think about flying? Thanks so much. Carol |
Hi Carol,
It sounds like another sinus perforation but there is no way to tell if it needs surgical intervention or what exact procedure via the internet. Whatever happened to the other sinus perf on the right side back in July? I think you said in a previous note that you were a smoker. Anytime a smoker has an extraction, the chances of developing a dry socket anyplace in the mouth and/or a sinus perforation of an upper tooth is more likely to occur than in someone who does not smoke. Also, the gum tissue will take longer to heal closed in a smoker... which can lead to a more extensive sinus perforation and infection. The reason for these complications is due to the lack of oxygen and red blood cells in the oral tissue caused by the chemicals in the tobacco. It is usually recommended to refrain from flying if you have a sinus perforation from an extracted tooth. The pressure can cause the perf to enlarge and become very painful. It is also recommended to not blow your nose and to cough with your mouth open to diminish the pressure on the sinuses until the sinus perforation has closed. Did you see the oral surgeon today? What did he say? Bryanna [/I]QUOTE=Silky;689935]I have the symptoms of a perforated sinus. I have air leaking out into the mouth. I also have the salty discharge leaking from the extraction site. It's been two weeks since the extraction of tooth #16. The salty discharge has just started to be somewhat less than it had been. I see the oral surgeon today. Do you think a surgical repair needs to be done at this point, or could the extraction hole still close on its own? Normally my gum tissue heals really fast, so I'm concerned about the hole still being open. Also, should the sinus be stitched or patched at this point? Also, I am supposed to fly out of town next Friday. I would not want to go if this could cause a problem with a sinus infection or tearing the perforation further. What do you think about flying? Thanks so much. Carol[/QUOTE] |
Hi Bryanna,
I'm not a smoker. Thought I'd get that out of the way first. ;-) The sinus perf on the right side healed totally. The surgeon had stitched it at the time of the extraction. I had air escaping symptoms for about 5 months, and then that cleared up. When I saw the oral surgeon today, he did an xray and examined the site, and he said there is no perf. Would an xray be pretty conclusive for that? I did some researching and found that oroantral fistula also has the symptoms of air escaping and salty discharge. Is that something different than a perf? Usually I heal very quickly in the gums, about a week. It's been two weeks, and he said the hole is a size of a dime in the extraction site. That's not normal for me. I asked him if he could close it, and he preferred not to. Could the opening just be stitched closed after two weeks. I'm afraid that this is open to the sinus and that's where I'm getting that salty taste. Oroantral fistula sounds pretty scary if it turns into a sinus infection. I've never had a sinus infection, and my sinuses have always been very clear. If this is an oroantral fistula, what would you recommend about flying then? You're so helpful. I really appreciate your advice! Thanks. Carol It sounds like another sinus perforation but there is no way to tell if it needs surgical intervention or what exact procedure via the internet. Whatever happened to the other sinus perf on the right side back in July? I think you said in a previous note that you were a smoker. Anytime a smoker has an extraction, the chances of developing a dry socket anyplace in the mouth and/or a sinus perforation of an upper tooth is more likely to occur than in someone who does not smoke. Also, the gum tissue will take longer to heal closed in a smoker... which can lead to a more extensive sinus perforation and infection. The reason for these complications is due to the lack of oxygen and red blood cells in the oral tissue caused by the chemicals in the tobacco. It is usually recommended to refrain from flying if you have a sinus perforation from an extracted tooth. The pressure can cause the perf to enlarge and become very painful. It is also recommended to not blow your nose and to cough with your mouth open to diminish the pressure on the sinuses until the sinus perforation has closed. Did you see the oral surgeon today? What did he say? Bryanna [/I]QUOTE=Silky;689935]I have the symptoms of a perforated sinus. I have air leaking out into the mouth. I also have the salty discharge leaking from the extraction site. It's been two weeks since the extraction of tooth #16. The salty discharge has just started to be somewhat less than it had been. I see the oral surgeon today. Do you think a surgical repair needs to be done at this point, or could the extraction hole still close on its own? Normally my gum tissue heals really fast, so I'm concerned about the hole still being open. Also, should the sinus be stitched or patched at this point? Also, I am supposed to fly out of town next Friday. I would not want to go if this could cause a problem with a sinus infection or tearing the perforation further. What do you think about flying? Thanks so much. Carol[/QUOTE][/QUOTE] |
Hi Bryanna,
I'm again thinking more it would be a perf. I'm having the same symptoms of runny nose, air leaking into mouth, and salty discharge that I had last time. I thought I heard that sometimes the perfs can be hard to find. With all these symptoms, I really feel worried about flying. What do you think? Thanks. Carol Quote:
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Hi Carol,
I must have you mixed up with someone else who asked a similar question... although it is odd that I knew you had a sinus perf on the upper right since you are not that person..... ??!! What did the oral surgeon say was the problem? Did he just dismiss your symptoms? The fact that your tooth was removed 2+ weeks ago, the gum area is still open and you have symptoms of a perf... I think another trip to a different oral surgeon might be helpful. Something is definitely going on. Sometimes you can see a sinus perf on a dental xray but not always. Sometimes it only shows up on a dental CT scan. Bryanna Quote:
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Carol,
It sounds like there is a "communication" between your mouth and your sinuses. Those symptoms do not occur for no reason. If it were me, I would get another opinion, possibly a dental CT scan and not fly anywhere until I knew what was going on. I know this is all very difficult and worrisome. If it is a perforated sinus that is not healing on it's own, then it can progress into an infection that is very difficult to eradicate completely. Would you be able to get a second opinion?? Bryanna Quote:
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Yes, I can get a second opinion. Sounds like a good idea.
How long is the time frame where a minor surgical repair can be done if necessary....before the bone or too much tissue grows in? Quote:
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Hi Bryanna,
I have an appt. for a second opinion for Thursday morning. Does a CT scan show a perf with good reliability? That's funny about the smoker and similar situation. Since July wasn't my other perf, I thought you either had me confused with someone else, or you were a mind reader. ;-) Carol It sounds like there is a "communication" between your mouth and your sinuses. Those symptoms do not occur for no reason. If it were me, I would get another opinion, possibly a dental CT scan and not fly anywhere until I knew what was going on. I know this is all very difficult and worrisome. If it is a perforated sinus that is not healing on it's own, then it can progress into an infection that is very difficult to eradicate completely. Would you be able to get a second opinion?? Bryanna [/QUOTE] [/QUOTE][/QUOTE] |
There is a time limit and it depends on how large of an opening there is. The real problem with a sinus perf is that the hole doesn't close which can lead to infection beyond the sinus. The bone becomes dry and doesn't fill in and there is no blood supply there for tissue to grow either.
So it is good that you are going for a second opinion this week. A DENTAL CT scan.... it has to be a dental one... can show a communication pretty well. If you get nowhere with the second oral surgeon, you could see and Ear Nose and Throat specialist because they deal with these things all of the time. Bryanna Quote:
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Bryanna,
Would a regular CT scan show a sinus perforation, or does it have to be a special dental CT scan? Thanks. Carol It sounds like there is a "communication" between your mouth and your sinuses. Those symptoms do not occur for no reason. If it were me, I would get another opinion, possibly a dental CT scan and not fly anywhere until I knew what was going on. I know this is all very difficult and worrisome. If it is a perforated sinus that is not healing on it's own, then it can progress into an infection that is very difficult to eradicate completely. Would you be able to get a second opinion?? Bryanna [/QUOTE] [/QUOTE][/QUOTE] |
Hi Carol,
A regular CT may show something. But the angles and detail of a dental CT scan are definitively looking for anatomical abnormalities and they show the oral and sinus cavity much clearer. These are done frequently, so there shouldn't be any question about doing it. I personally would request a dental CT scan only. Please let me know how things go! Bryanna Quote:
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Hi Bryanna,
I found a place that had a dental CT scan. He was a regular dentist, not an oral surgeon. He said it was best to wait and see if the hole would close on it's own yet. I didn't feel too comfortable about that. He said the surgery could be done after a few months, and that it's easier to do the surgery if you wait because there will be more tissue. He never heard of someone getting a sinus infection from a perf. Geez! I did find an oral surgeon who has a dental CT scan. Do you think it's best to go to another dentist or an ENT. Would the ENT do a different kind of surgery? It would be less invasive to go in through the mouth for repair, wouldn't it? Quote:
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Hi Bryanna,
When they repair a perforation, do they just close the hole in the gum, or do they need to cover the sinus with something also? I'm so frustrated how these doctors are blowing off the symptoms and the fact that the hole didn't close at almost 4 weeks. It wouldn't make sense to go to the ER, would it? Do you think it's still best to go to another Oral Surgeon or to an ENT? The dental scan I had done showed the outline of the tooths roots. Where the roots met the sinus, the outline disappeared which he said means the tooth was inside the sinus. Thanks. Carol I found a place that had a dental CT scan. He was a regular dentist, not an oral surgeon. He said it was best to wait and see if the hole would close on it's own yet. I didn't feel too comfortable about that. He said the surgery could be done after a few months, and that it's easier to do the surgery if you wait because there will be more tissue. He never heard of someone getting a sinus infection from a perf. Geez! I did find an oral surgeon who has a dental CT scan. Do you think it's best to go to another dentist or an ENT. Would the ENT do a different kind of surgery? It would be less invasive to go in through the mouth for repair, wouldn't it?[/QUOTE] |
Hi Carol,
Oye.... dentists can be such jerks.... sorry, but they really can. This guy that you saw is SO mistaken on the information he gave to you....not only can waiting to treat this be a problem later on, but sinus infections commonly occur from a sinus perf from an extracted tooth. To elaborate and help answer your questions, here is a link I found that gives a good description of your situation and the question on there was answered by an oral surgeon. http://en.allexperts.com/q/Dentistry...traction-1.htm I know you are very frustrated over this and rightfully so!! If it is any consolation, your situation is not uncommon and I often hear of people going to several dentists before they get the right treatment. Consulting an ENT doctor may still be a good option for you because it can reaffirm that there is a problem and his opinion may actually be helpful in getting your problem corrected by a dentist. ENT drs generally perform surgery along with a dental surgeon once the sinus has become infected. That's the progression of a sinus perf that you are trying to avoid in the first place. Please keep me informed of what's going on. Bryanna Quote:
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Hi Bryanna,
I found an oral surgeon that seems to be willing to help me. When he looked at the extraction site he said that it would be easy to fix. He did an i cat scan and didn't see any noticeable breaks in the sinus floor. So I'm guessing they were too small to be seen. He said the surgery that he would do would be a flap surgery. He said he's even done this type of surgery a year after an extraction. He thought I might be best served not to do the flap right away. He gave me an antibiotic for a week, since he was concerned about the salty drainage and something is leaking somewhere. He thought the hole might close in a week or two. The fact that there is still drainage......does that mean the hole will probably not close. I asked him how big the hole was. He said about 1 cm. I get different answers when dentists look so not sure how accurate their estimate is. I think it's hard for them to see the hole being so far back and kind of dark to see. Since he's talking about the flap surgery it seems he must think the sinus area will heal by itself, and is only concerned with the hole in the gum. What would you do now? Does any of the info he gave me sound not right to you? He left it that I would come back if I needed. He would probably do the flap surgery if I go back, and asked him to. Thanks! Carol |
Hi Carol,
It is very hard for me to say if the hole will close on it's own as I have not seen you clinically or radiographically. The salty taste indicates a communication between your sinus and your mouth. It could be as tiny as a pinhole but any communication between the two could result in infection. Yes, oral surgeons have closed sinus perfs a year or more ater the extraction of the tooth. But that is only because the patient was not evaluated earlier than that. So yes, it can be done but it's not ideal to wait that long. During the flap procedure, he may cover the opening in the sinus with a piece of collagen membrane and then suture the incision closed over that membrane. You just may need some more time to heal... it's hard to say. I would take the antibiotic and then wait one more week after that is done to see how it is. If you are still getting that salty taste, then revisit the oral surgeon. Sometimes these things heal on their own if there is no infection. Hopefully that is the case with you!! Keep me informed .... ok... Bryanna Quote:
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Hi Bryanna,
Waiting really makes me nervous knowing it is there. Is there some reason not to schedule a flap surgery right away? Are there problems with the flap surgery that it is better to wait another week yet? Thanks. Carol |
Hi Carol,
I am the same way... if I think something is wrong, I generally get anxious to fix it! However, sometimes things do heal on their own and this may be one of those times. The only reason to wait is.... it may be "slowly" healing on it's own which means avoiding unnecessary surgery. I would wait the two weeks as I said and revisit it if the salty taste does not clear on it's own within that time. You know the perf is small, so the surgery would most likely be minimal if it comes down to doing that. Please try not to worry about it..... ~'.'~ Bryanna Quote:
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Hi Bryanna,
Since it's been almost 5 weeks since the extraction, is it possible to heal on its own yet? Would you ask for more antibiotics after the week's worth runs out? Do the antibiotics really help? Thanks! Carol |
Carol,
Everyone heals differently. Perforations in the sinus from a tooth extraction can heal slowly for many reasons and take months to heal completely. One is bacteria may have been at that site and prevented it from healing faster in the first place... secondly the immune system plays a part in healing everything and diet along with medicines and medical conditions can slow the healing process also. The salty taste is the biggest symptom or indicating factor that the perf has not closed. But if that is slowly diminishing, then it indicates the opening is closing. If that is the case, then you probably won't need another round of antibiotics. If the salty taste is not diminishing and/or you develop pressure in your sinuses, then you would need to have the oral surgeon re-evaluate it. Bryanna Quote:
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Hi,
I had my wisdom teeth removed in july. Both my sinuses were perforated and they decided to perform surgery again to close the holes (on monday). I haven't sneezed or haven't blown my nose since. I take my medication carefully, but since yesterday I started tasting that salty fluid again. I almost started to cry, I had really hoped I'd never have to experience that taste again in my life. Now my worry is that the surgery failed. Or should I just be more patient. I know 5 days is ashort time to heal, but I've been running around with this for almost two months and it's really getting to me. :( |
Hi sushitastic,
That salty taste is indicative of a communication between the sinuses and the mouth/throat. One thing that could have happened is the collagen membrane used during the surgery to close the hole has shifted causing a slight opening again. However, the hole could still close on it's own. Do you smoke? If so, then this alone could cause a disruption in the surgical healing. Are you rinsing with mouthwash? If so stop and rinse only with warm salt water to keep the surgical areas clean. Have you been drinking threw a straw? Do you have sinus congestion and/or post nasal drip? Sometimes a salty taste comes from the sinus fluid dripping down the back of the throat. When do you see your dentist for a post op visit? Bryanna Quote:
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Hi,
I'm not a smoker. The ENT didn't say anything about using a collagen membrane. Is it possible he did the surgery without the membrane? I went tot the doctor because it really started hurting and I got a fever too. She prescribed me other antibiotics (stronger) cause I have an infection. I haven't sneezed or blown my nose and I haven't used a straw either. I can feel the air going through sometimes when I speak or breathe so there's definitely a hole. greets Quote:
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Hi sushitastic,
So your sinus perf was repaired by an ENT dr and not an oral surgeon? Generally, since the sinus tissue is too delicate to suture, a piece of collagen membrane is placed over the sinus perf to encourage the hole to close. Did you have a sinus infection at the time of the surgery? If you are feeling air when you speak, then yes, there is definitely an opening. What did your dr recommend that you do? Bryanna Quote:
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Hi Bryanna,
The hole in the gum did close now. I'm still having the air escaping and runny nose. The runny nose has somewhat improved. The air escaping seems to be the same as it was. The salty taste is a lot less now, though still seems to be there a little. A regular dentist did the i cat scan. He's going to send it to a radiologist to look at it at a dental college. It will take a week to get the results. If the gum is closed is there still much chance for infection? If they find something needs to be repaired, can they still go in through the gum to put a membrane on the sinus after 2 months? Do you think this is something that could still heal on its own? Thanks! Carol |
Hi Carol,
I don't know if this is your case or not but sometimes the gum tissue looks completely closed but still has a pinhole opening. Even a slight opening the size of a thread could cause the same symptoms as a perf. I think it's a good idea to have a radiologist look at the scan. If there is an opening, surgery may or may not be an option right now as the dentist may want to give it some more time. The type of surgery to close a sinus perf depends on the location of the opening. It sounds like things are improving...... so hopefully a little more time is all that is needed!! Keep us posted on how you're doing. Bryanna Quote:
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Thanks for all the answers! |
Hi sushitastic,
It is concerning to take so much antibiotic medication because for one thing it destroys much of the healthy bacteria in the digestive system. Do you take a probiotic every day? This is a nutritional supplement that helps to restore the good bacteria in the digestive tract that is killed off by the antibiotic. An excellent one is called Culturelle.... can be bought online at vitacost.com. The membrane can still be placed and most of the time using local anesthetic. After you give the oral surgeon your symptoms, he will take an xray to determine if the membrane is still in place and to evaluate the area for signs of a perf. Just keep doing what you have been doing and keep avoiding those things that you know you should. Let us know how your appointment goes on monday! Bryanna Quote:
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Hello,
my appointment had been rescheduled to today. I'm feeling much better now and the wound is healing, I can feel that the hole is getting smaller as less air is running through it as I speak or breathe. The oral surgeon told me to come and see him again next week to remove the stitches. He recommended to leave them in for one more week to advance the healing. My cheek is also still a bit swollen, but I'm sooooo relieved that everything is finally healing nicely! |
Yay! That's great news.... hopefully everything will continue to heal just fine. Thanks for letting us know =))
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Hi Bryanna,
It's getting so frustrating. The dentist is having trouble making a disk of the icat to send to the radiologist. It's been 3 or 4 weeks not that I've been waiting. They keep making corrupted disks. Tomorrow they are having someone remote look at their data online to try to find out what the problem with their machine is. I've about given up on thinking they'll ever get this straightened out, but a radiologist report would sure be helpful. I'm wondering now about flying for a Thanksgiving trip. I canceled my flight in September because of all the symptoms going on. The salty drainage has stopped. The air escaping is less, but it's most noticeable if I lay on the side of the extraction and swallow. Then I can hear soft noises. Thanksgiving will be 3 months after the extraction. What do you think about flying? I just wish I had the additional information of a radiology report. As far as runny nose, it now seems to be just a little bit of wetness after eating. It's not exactly normal for me, but seems pretty minor now. Thanks. Carol |
Hi Carol,
It is up to the dentist to find a way, whether it be new software in his office or seek outside help, to get you a copy of that icat. He is responsible to make a copy in a reasonable amount of time. I agree that the radiologist report would be helpful. With that said..... it sounds like the perf is healing based on your current symptoms. However, it may or may not be completely healed by thanksgiving. Sometimes a tiny perf will not be problem if you were to fly. But without someone evaluating the situation just prior to flying, there is no way to guess what the outcome would be. Boy, this has been a long ordeal and very disruptive to your life! Hopefully things will resolve soon. Keep us posted on how you're doing. Bryanna Quote:
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Hi Bryanna,
Was wondering if it is okay to have a crown done while I'm still dealing with a perforation and healing? Or is it better to wait with the crown? A tooth needs a crown eventually, though it is not necessary to have it done right away. There is no problem with the tooth right now, other than it has a huge filling and will need a crown at some point. A dentist is putting pressure on me to have the crown done. I have a temp crown on a tooth right now. The dentist wants to also put a crown on the tooth next to the temp crown. He says if we do both crowns at the same there will be better control with the crowns. I see him on Monday. Last time I saw him, he said we need to do both crowns or nothing. I hope he doesn't have that attitude on Monday. Also, if I wait till next year with the additional crown my insurance will cover it. Thanks! Carol |
Hi Carol,
The sinus perf is irrelevant to having crowns put on other teeth. The reason he wants to do both at the same time is because of a few reasons... one, less chair-time because less vists ....... two, the fewer the visits, the fewer the anesthetic injections..... three, the lab can make the porcelain on both crowns from the same dye lot, so they will match perfectly. If done at two separate times, the porcelain may not be exactly the same hue although this may or may not be too noticable..... and four, the crowns could be made from the same mold taken of your mouth which means the bite will not have to be readjusted as much. As for the insurance.... you may be close to your yearly maximum at this point and want to hold off with the second crown until next year to get some coverage on it. Ask your dentist to submit one crown for this year and the other one in January. To make this legal, you could ask him to cement one permanent crown on in December and the other one in January! This way both crowns are made at the same time, the porcelain dye lot is the same, and there will be minimum bite adjustments for both crowns. You would only be in the chair one extra visit which would be to insert the crown in January. Did I explain that ok......?? Bryanna Quote:
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Thanks Bryanna,
You explained it perfectly. Dentist is acting like he wants to wait for all the perf symptoms to be gone before he does the second crown. That could take quite a while yet, since last time the symptoms didn't stop for 5 or 6 months. The tooth with the temp crown is right next to the extraction site. He says he needs to let it heal more to get a decent impression. Does that sound right? I was told that a good copy was able to be made of the icat now. So if everything goes right, I might get the results from the radiologist to read the scan in a week. Carol |
Hi Carol,
Well, with regard to taking an impression....if there is an opening from the sinus through the gum tissue, meaning there is still a hole or depression in the gum tissue connecting to the sinus perf.... then it is best to wait until the area has healed completely. Or if the dentist feels that the suction from removing the impression material from your mouth is going to disturb the sinus perf, then it is best to wait. Otherwise, if the sinus perf is practically closed up and there is no communication to the mouth, an impression should be ok. But he should be the judge of that because he is looking at it clinically. Also, iIf the surgical site has not filled in completely, then it is best to wait to take the impression for the crown. Glad to hear that they finally have a good copy of the icat! Keep us posted on the findings of that! Bryanna Quote:
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