Questions regarding possible perforated sinus
 

Hi everyone,
This is my first post. I have been reading all the posts about sinus perforation since I have a suspected one (3D imaging tomorrow morning, seeing oral surgeon) with a suspected periapical abscess of old root-canaled 1st molar. It just started being painful this week, although I had referred pain into lower jaw for some time.

If it is abscessing, I want to have it removed and I am sure my oral surgeon will do that with assisted IV tomorrow morning, if necessary. I am worried about the possibility of sinus perforation since salty fluid is coming from near the tooth as far as I can tell, and I am a bit sniffly. I have been on antibiotics (amoxicillin and flagyl) for a week now, but still have swelling.

What should I be looking for? Is it safe to remove the tooth at the oral surgeon's office? Would he put the membrane into the site if he sees a perforation?

Trying to learn as much as I can from reading Bryanna's posts!

Thanks to everyone for providing your stories.

Marcie

Extraction done today
 

I thought I should post an update:

I had a CAT scan done last night (not a 3D dental one, just a traditional 64 slice one used in hospitals) and they didn't see sinus penetration. No evidence of sinusitis on that either which was good. That's the good news.

I saw the oral surgeon and he did another pan x-ray. He saw what he thought was an obvious abscess of the upper 1st molar (which was ROOT CANALED so I'll never have another one of those). I had it extracted this morning, and the oral surgeon said the roots did not extend into the sinus cavity and that he didn't see any obvious perforations of the sinus cavity itself. :) He cleaned it out very well, according to the dental assistant (She told my sister that - I was kind of out of it still) who confirmed two of the three roots were abscessed.

So no membrane, just stitches, perchlor antibiotic rinse, ibuprofen, T3 as needed and antibiotics: metronidazole, and Amoxicillin/Clavulanic Acid.

I am hoping all goes well. One thing that concerned me, is that my oral surgeon said if it was a bad infection even with an obvious sinus perforation, that he wouldn't put membrane in right away - I was surprised at that. That he would rather be satisfied that the infection dry up since most tears heal on their own through fibrous tissue formation? Wouldn't it be better to have an ENT and oral surgeon together in this case so both could do their part? confused here.

I am following all post surgical instructions and hoping for the best.

Hi Marcie,

Glad you had that tooth out! Root canaled teeth are always infected and once again, your experience tells that story.

Sometimes when there is a sinus perforation and there is a large infection, surgeons will hold off on placing the membrane to see if the perf closes on it's own. Infection and any foreign substance often don't mix real well. So it's probably better to see if the sinus heals on it's own.

I'm sure the surgeon wants to see you post op in a week or two?

Bryanna

Bryanna
 

Hi Bryanna,
Thank you for replying!

No, there isn't anything scheduled post op with my surgeon (of course) but I can ask for one. The site is not bleeding but difficult to see and I of course am still in pain.

I am still feeling the salty taste tonight. My nose isn't running.

Would taking sudafed help? Not sure .... just worried really. I was instructed not to r
Thread Questions regarding possible perforated sinus
Forum Dentistry & Dental Issues
Title
inse til 24 hours post op. I could pick up sudafed in the morning if it might help.

Miserable and in pain Bryanna please advise
 

Well this hasn't gone smoothly at all.
Fluid is now sloshing back and forth, through my healing site and into my mouth and causing immense pain in my ears and sinus. Worse than anything I have ever experienced.

Taking sudafed, on antibiotics, not sure what else to do. (Not blowing nose,
I suspect I must have quite a large perforation and am miserable.

Question: do I need a 3D CT scan?
Who would repair this? (Oral surgeon or ENT?)
How long should I wait?

Bryanna, I hope you see this post.

Raye,

Do not wait... see the oral surgeon tomorrow.

If the sinus is open, there is no amount of decongestant that will help. The antibiotic you are on may not be adequate for this either ..... you have to be seen clinically.

In the meantime, rinse with warm salt water 3-4 times during the day to keep the extraction site clean. Do not rinse with any mouthwash... none. You could apply moist heat to that side of your face and sinus... not dry heat, moist only and no ice. Do that every hour or so until you see the surgeon. That will help keep the blood flowing in that area which is what you want to help reduce the pressure from the inflammation (infection?).

Seriously, tomorrow without fail see the os.

Check back with us .... I know this is awful, but you'll be okay.
Bryanna

Bryanna
 

The oral surgeon who did the surgery is insisting that it is not a perforation
so upset
2 ER visits for pain that is incredibly intense
fluid coming out of all my upper teeth and bottom jaw
CT showed nothing but it was not a dental CT

I see my dentist tomorrow and the Oral surgery team at dalhousie will see me tomorrow once I see my dentist in the morning.

This has been the worst experience

Raye

Raye,

When you say fluid is coming out.... can you describe where it is coming from exactly? What about the color, taste and smell? Are you pressing on these areas to make it come out or is it coming out on it's own? Does it only occur when you put your head down or forward? Does it occur when are sleeping and do you wake up with this fluid in your mouth? Is it also coming out of your nose?

Unfortunately, a regular CT scan may not be helpful. A dental scan shows the different "slices" of the oral and sinus cavity. Why didn't they do a dental scan? What is the oral surgeons diagnosis if not a sinus perforation?

You poor thing :/ I know things are different in India than in the US. You really have to assert yourself and keep trying to get help.

Keep us posted okay...
Bryanna

Bryanna
 

Hi Bryanna,
ENT confirmed on CT that I have a tear...3-4 mm as of last night and says my sinuses are not infected...good news. My oral surgeon is such a liar. Do I believe it? i don't know what to believe anymore. The ENT said from last night til this morning it was only 1 mm by viewing it. He did a scope first thing this morning

Anyway, Dalhousie medical team of Oral and Maxillofacial surgery is fixing it .... on Thursday I am booked (was supposed to have it today but blizzard prevented us).

I am not pressing on any areas to make it come out ...it is coming out on its own. It is clear. Not sure about the taste....snotty like. Not coming out of my nose anymore...that stopped.


Just praying that it'll be okay til Thursday. I am still on heat (moist heat which is helping)

It helps just talking to you Bryanna, to be honest.
Raye

Also the extraction site is closed so this is freaking me out
Raye

Raye,

The oral surgeon is an *****. Your symptoms are classic sinus perf or tear. Thank God for the ENT dr!! I'm so sorry for all that you have been through. :/

The fact that the tissue has closed over is okay. They can still fix the tear anyway and hopefully that will be it! However..... if by chance your symptoms drastically subside by thursday, ask them to take another xray to make sure it is still open. I say this because if the tear reduced from 3-4mm to 1 mm then it may just close on it's own.

Hang in there Raye..... you will be okay.

Bryanna

Thanks Bryanna
 

Thanks Bryanna.
That's exactly what the ENT said lol. He also thinks I have trigeminal neuralgia from all this, but not sure really.

I still applied the moist heat yesterday which was immensely helpful.

My dentist was so upset at the original oral surgeon - and the ENT told me what he thought of my original oral surgeon which was NOT nice :) I have a team of good ones now (I believe affiliated with a group I have seen you recommend!) They could NOT BELIEVE the original oral surgeon's behaviour and lack of complication followup.


And guess who calls me today? The original oral surgeon (I am sure he heard through the grapevine some rumblings from colleagues, worried.) I of course let him have it and let him know what the others thought of him! I intend to report him to the college of physicians and surgeons in Canada.

Yes it's true in Canada we have to push - it gets tiresome when things go wrong.

Thanks for all your help and I'll keep posting updates

Raye (Nickname: Marcie)

Raye,

I am glad to hear that the ENT concurs with me... reassures me that I am understanding you correctly :)

Is the new dental group affiliated with the IAOMT organization? They are the ones I usually recommend to people as a referral source.

I didn't realize you were in Canada. When you said Dalhousie I assumed India! Yea, keep pushing.... sometimes you have to do that to be heard.

I check back later....
Bryanna

Well what a time it has been. Saw the oral surgeon in Halifax who agreed to fix my perforation in surgery the next day, then his decision was overturned by his superior who did not see or assess me himself. (Teaching hospital)

So back to dentist, a third oral surgeon, ENT still following. Here it is almost 7 weeks later, and an xray taken on Thursday by a new dentist still showed a oroantral communication...the extraction site is healing nicely but the edge of my molar beside it is still dripping sinus fluid. The dentist called the third oral surgeon but he doesn't want to go against the ENT, and wanted me to call the ENT. Why don't these specialists talk to each other?????

The ENT sent me for another CT on Friday (not the dental kind - we don't have that at our regional hospital) but he wouldn't look at the dental x-rays. So I am waiting to hear back from the ENT this morning but am still very upset that all this has happened. I finished my antibiotics 2 weeks ago but think I should be on them still so will ask today.

I am considering going to Ontario for care instead. Bryanna, any recommendations would be most helpful.

Also, who is the best doc to repair a perforation? An oral surgeon or an ENT?

One of the oral surgeons (the one who overturned the surgery - he wanted me to go back to the original oral surgeon who tore my sinus and refused followup) said an ENT shouldn't be fixing this, so I am a little concerned about that as well.

Hi Raye,

WHY did the superior nix the oral surgery?? That is a huge question for me and one that I would seek the answer on because it was one of two things.... either he didn't want anyone in the program to be involved in your case for fear of a law suit or he didn't feel there was a need to have it done.

Have you insisted that the doctors speak directly to each other? That would make the most sense... they need to discuss your case and concur on a decision. Not have you go back and forth like this.

The routine CT scans may not show what they need and they know that. So please no more of these types of scans.... not healthy for you to keep doing that. Because the sinus still draining as you stated in your post, there may not be a need for another antibiotic at this time. I would continue to rinse with warm salt water 3-4 times a day to keep the bacteria down.

Regarding who does the sinus closure procedure.... it really all depends what is involved in your particular case. Oral surgeons repair sinus perfs all of the time. ENT's get involved with the surgery depending on where the perforation is and if the sinus is very infected. Again, this is something that the doctors need to discuss with each other.

I am so sorry you are going through this. Please stay firm in your attempt to get help... don't let anyone make you feel like your hands are tied. Be insistent and expect these drs to communicate with each other. I know that may not be easy for you to do....but it may be the only way to get this taken care of. Believe me, if it were happening to any one of them, they would not be passive by any means!

Stay in touch ok...
Bryanna

Hi Bryanna,
the superior nixed the surgery because he wanted me to go back to the original oral surgeon - the one who refused follow up. I tried to explain to him, but he wouldn't listen.

That's why my dentist referred me to another oral surgeon afterwards.

I am trying to get them to talk to each other. I don't have an infection (thank goodness) and continue the salt water rinses. I have involved our occupational health nurse at my work and hopefully I'll get some of these specialists to actually talk to each other, and get a dental scan that will actually show something.

Raye