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

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.

Dear Bryanna,

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

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

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?

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. :Dunno:

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

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.

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?

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. :-)

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?

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?

Dear Bryanna,

Thank you so much for checking the x-ray.
This is unbelievable. I spent the past 5-8 years trying to convince dentists (at least 10) and ENT that there is something going on in my face. Numerous X-rays, nothing.
Once in a while I woke up with a weird feeling on my left side, a little swelling.
Because I was attacked 10 years ago (broken eardrum, upper teeths on the left side) a few dentists blamed it on that. ENT checked my sinuses last time a year ago and gave me the all clear.

Noone ever mentioned of a visible ongoing infection. To be fair, had no other symptoms at all. No pain, running nose, facial pressure, nothing.
In fact last week on Thursday I saw a dentist who said he would re-fill the RC tooth on the left side and it will be ok. Not the roots, that I already had done less than a year ago. He was very convincing. I went back the next day and had them pulled by another dentist. After the extractions the dentist said nothing about sinus perforation and when I called them on my way home that something is wrong I was told that it heals by itself, not to worry.

Sorry, back to the unfortunate present :).

Now I think the right side (with the one tooth deep in the sinus) despite the second operation is still open. Or open again, and hat was the noise yesterday morning, no idea. Still swollen, much less though. I have been sleeping in a semi-sitting position since the extraction. Pressure in the face or rather head is bad. Nothing comes from my nose.

The affected first molar: if the hole does not close on its own than while having the operation I will have that removed too. If the hole closes by any chance and the tooth is affected still will have to have it pulled in the close future, resulting in another sinus opening. Now I rather wish it would not close this time.
I rather remove all teeth that might have a negative effect on my health, also the ones that are likely to become a problem source soon. Will do it all within a year whatever it takes and be all clear after that, with some nice dentures.


Yes please please would you tell me what else of concern can you see on the X-ray?
It would help a lot in solving these issues and in finding a doctor who is more likely to take on complicated problems.
For example the tooth before the first molar might also be affected you think?

Thank you. :Thank you: Thank you.
Elna

Hi ELna,

It is not unusual, as you may have read on many occasions on this forum, for people to see several dentists/doctors about chronic symptoms and be told everything was fine. Sometimes dentists zero in on one particular area rather than the whole picture because they either don't want to inform the patient of everything that is going on for fear that the patient will be overwhelmed and not come back OR they get the impression that the patient only wants them to zero in on one thing at a time. I am not justifying this as a proper way of doing things, but it is often what happens.

I am going to assume that the xray you posted is a mirror image of your mouth. Which is what it should be if you did not flip the xray over before you copied it. In other words YOUR right side, which is marked with a large "R" is on the left side of this photo when looking at it.

The panoramic xray is very diagnostic if you want a view of the upper and lower jaw in their entirety. However, for better detection of decay and certain pathology, it is wise to have a full series of xrays, this is 18-20 small xrays, done in addition to this panoramic xray. Those xrays would give a close up view of each tooth and be more diagnostic at detecting cavities.

With that said...........
On this panoramic xray, your left side has a wisdom tooth, #16, that may have extensive decay on the back portion and even under the existing filling. The rc molar tooth next to that, #15, that you just had removed showed radio graphic pathology surrounding that tooth which appears to be in communication with your sinus. You are missing teeth #13 and 14. Tooth #12 has a large filling with possible decay around the filling and possible pathology around the root surface. The vitality of that tooth may be questionable because the central nerve chambers are only partially visible. Which could indicate calcification of the canals and/or infection. This could also be caused by the injury that you sustained to that side of your face.

Across the upper arch over to the wisdom tooth #1, this tooth may have decay on the mesial (next to #2) near the gum line. Tooth #2 which you recently had removed, appeared to be in communication with the sinus and had many things going on with it. The next tooth #3 is possibly non vital and appears in communication with the sinus. Most of the upper portion of this tooth is surrounded by a large radio-lucent (dark) area which could be infection. Teeth #4 and 5 should be evaluated for decay with those small xrays I mentioned.

Your lower right side, you are missing a molar and then tooth #29 has a cavity on the distal (back) portion of the tooth high up near the occlusal (biting) surface. Going over to tooth #20 the lower left root canaled tooth there may be decay on the distal (back) portion along the gum line underneath the filling.

The small xrays, called periapical and bitewings, would be very helpful in diagnosing decay and pathology in the areas that I mentioned and would give a clearer view of the other teeth as well. Without those xrays, it is easy to miss certain areas of decay or pathology.

How are you feeling today.... how is the swelling and the air sounds??

Dear Bryanna,

Thank you very much for all this information. It is priceless and will help me a lot in trying to solve all problems. Now to find a dentist in London who is willing to take the time you did to analyse the situation and also has the expertise to see it as it is plus willing to actually fix things. Good luck to me but thanks to you I have something to measure by. I'll ask about the first molar, whoever is honest about it might be the ONE.

The series of small x-rays is what I'll start with once this is over.
Swelling is gone as of yesterday (there was a hard lump on the right side that worried me but gone :-)), left side feels normal, the right one felt better until yesterday evening when after a week of silence and liquids I raised my voice for one word (for safety), felt pressure and now it's more tender and funny again. I didn't feel it rip or anything so I'm hoping it's just been stretched. Very frustrated, I was so careful. But I am not testing it until after the stitches are removed. The weird air-sound didn't repeat.

I hope that it will close for now, I can have a break, find a dentist to fill all cavities one by one, take the last root-canaled out and meanwhile I can find an oral surgeon to deal with the first molar. Maybe a good dentist knows a good OS. I'll probably have the top wisdom teeth removed together with that one if necessary.

I have one more week now before the stitches are removed. I'm thinking of going somewhere else for that too.

Thank you. I'm sorry, this is a not-so-good day. The last dentist before this I saw in December, he was keen on making a crown and told me nothing about molars either.

Thank you so much. :You-Rock:
Elna

It did break yesterday. It would have healed. I have not been using nasal spray for 2 days, now I decided to give it a go and I could feel a sucking (and pain) on the right side I have not felt when using it previously. :Bawling:
(not crying, can't blow my nose)

Is there any chance for it to heal on its own now? Had no problem with the nasal spray before at all.
Thank you

Stitches
 

Dear Bryanna,
Hope you are well.
I am going back to see the 1st OS tomorrow as figured he can't do much damage removing the stitches but made an appointment to an apparently really good delntist to proceed with the rest next week. She is young and a dentist but with excellent reviews and willingness to help plus works one day a week on the OS ward in a hospital.
Also made an appointment to my GP and will ask him to refer me to OS to check the damage. This will take weeks / months but in that case the doctor will see the end result and can advise on the first molar.

The OS I'm seeing tomorrow said he will remove both stitches. The left side will be two weeks on Saturday and feels ok, but the right side is only 10 days since surgery by then and does not feel right - I just started to have a better feeling yesterday.
I'm worried he'll insist on removing it tomorrow. That's not his work and he's not here next week. In general, should I keep myself to the two weeks the operating surgeon said (he won't be here either but someone else can remove it next week)?
Do a few days make a difference at this stage if it's not closed yet or anyhow?
Can I wait until Monday and have them both removed then?

Thank you so much again.
Elna

Hi ELna,

All of the answers to your questions depend on what is going on clinically. Meaning, your situation needs to be evaluated clinically, visually and perhaps radio graphically as well. There is no standard remedy or standard time frame for a sinus perforation because there are various contributing factors as to why the sinus is perforated, how large of a perforation it is, and what is causing it to stay perforated. Those all require clinical evaluation.

Any general dentist, unless they have extensive training in oral surgery, will most likely not be able to address your sinus situation. They are just not educated on how to deal with it. If they are a new general dentist then they have little to no experience dealing with complicated sinus perforations. I just want you to be aware of that. When you see the OS to remove the stitches, tell him all of the symptoms that you have been having. Sometimes just one xray will show whether or not the sinus is still open and it can show pathology indicating infection. So please don't be shy about telling them to take an xray of that area.

Hopefully this visit will be better than the past. Keep in touch........

Thank you Bryanna, for all the answers. Had the stitches removed from the left side and going back to have the ones from the right side removed on Tuesday.
Can I have one last question please?
I was taking Amoxicillin 500 for 2 weeks which ran out yesterday. The OS said the one with the stitches still in is a bit infected what he thinks due to the stitches themselves now AND there is still an opening there. I asked him whether I should carry on with the antibiotics until the stitches are out but he said 'not for now'.
I feel something new and not good on my right side this evening.
Do you think people with sinus perforation should stay on antibiotics at least until the stitches are out? An infection now straight walks up to the sinus doesn't it? I can't have another lingering condition really.

Thank you. This was the last one really. Thank you!
Elna

Hi ELna,

I don't mind your questions, really. Feel free to ask them here ;)

Staying on the antibiotic does not necessarily need to be done for all types of infections. In your case, to not renew the prescription is a judgement call by the oral surgeon. However, the ongoing symptoms and now new symptoms with your right side seem to indicate a chronic infection. As I stated to you previously after you posted the panoramic xray, there appears to be a large radiolucent (black) area in the bone/sinus above the first molar and recently extracted second molar. I do not know why your dentist is not reviewing that pathology with you.

If the symptoms on the right side are not better or gone by Monday, please call the oral surgeon and report your symptoms to him. I wish there was more I could offer you about this, but your dental problem requires a thorough clinical evaluation and additional radiographs.

Did the OS instruct you to continue using a nasal spray? Did you ask him about using saline spray instead of the other? Did he suggest that you rinse your mouth with warm salt water rinses a few times a day?

Dear Bryanna,

Thank you.
I tried the saline nasal spray but as I can't blow the nose it did not do any good yet - I'm keeping it for later. I used the decongestant spray for the first week then took Sudafed for the second week and now I'm going with nothing for a few days, returning to the spray for a couple of days if needed. Even though I feel a bit wet after drinking or brushing the teeth, its not uncomfortably blocked.

Had the last stitches removed yesterday. Booked an appointment at a hospital a month from now to check the sinuses.

I know it is still open, but feels a lot better and I really hope it will heal on its own now.
I have another problem though, one I wasn't paying attention to because I thought it was caused by the stitches. Where the operation was more severe, on the right side, things are not moving as they should. It has nothing to do with RHS, it is something caused by either the injections or the sutures. For a good week I had a hard lump that slowly went away. I was scared to move my mouth too much, didn't eat talk or do much at all. The lump is gone, I was told there is no infection.
But I can't smile all the way, it feels like the inside of my cheek is smaller or something. My eye is pulling too a bit. I'm scared of trying to push it in case I break the healing membrane but I'm very concerned.
If the injection in the cheek from the inside hit a nerve or sg will this feeling go away? Have you heard of anything like this? Please, I do know it's not RHS, that I know inside out. But it would kill me to lose movement now because of dental work after having recovered (facially) from RHS.

Thank you so much.
Elna

ELna,

I really don't know what is going on with the right side. The pulling of your eye is a bit concerning. Did the dentist know about this yesterday when he removed the stitches? What are you afraid to push in? Is the lump still there or what feels like it needs to be pushed in?

Bryanna

I'm scared to push smiling and trying my mouth to widen all the way. And the right side just above the operation site seems a tiny bit swollen but it's like more the face than the gum.
No other symptoms, I feel almost better than before the extractions.
Yes I mentioned, no answer, some slight shoulder movement and guilt in the eyes.
I didn't push him as I know he genuinely doesn't have a clue and. I just hope it goes away on its own. Will wait one more week and start facial exercise and soft massage....
I'm not going to see any other doctor for a month - wouldn't let anyone touch anything now anyway.

Thank you Bryanna, will post what happened later and try not to panic until. :Thanx:

Well, that's sorted. The stitches did hold something somewhere because what I only suspected yesterday - that the hole is open is certain now - like on the first day.
I'm beyond desperate. RELIGIOUSLY followed all advice, didn't even eat only liquids, no sneezing, no blowing the nose, talking or bending.

Now liquid and air goes again and the pulling is gone. Appears like something was stitched somewhere and without the sutures it broke lose.

question. Can the tissue that was used to cover the hold prevent it from closing on its own? I can not have another operation now - I have an appointment a month from now.
Is there any chance at all for it to heal on its own now? Any?

There is no infection, no pain.
I scared what's next.

Thank you.

ELna,

The pulling you had may have been due to the way the dentist stitched the wound closed. He may have pulled some of your upper cheek tissue over with the sutures to close it. Once he removed those sutures, the wound opened up. This indicates that the wound had not healed closed in spite of being sutured. I don't know what is preventing the sinus and the wound from healing if he tells you everything looks fine and there is no infection.

Obviously the sinus is open. Why he is not concerned baffles me. I know you have been careful to avoid doing certain things. So let's look at it from a different perspective. What are you doing? What are you eating, brushing your teeth with, rinsing with, what medications do you take, do you smoke, do you drink soda or alcohol...? I am just trying to see if anything in your lifestyle may be hindering the healing of the sinus.

On another note... I am glad that you are feeling better in spite of all this going on!

Dear Bryanna,

Thank you.
The OS who operated (both) are not back for another two weeks so the one who removed the stitches was just another dentist in the practice. It costs a lot just to be seen by an OS somewhere else and as I simply couldn't face another procedure right now will just wait I guess. But again, should be seen to be told there is hope for closing on its own...

I take nothing but vitamin c, multivitamins, l-lysine and homeopathic Arnica montana pillules to speed up (haha) healing, drink a tablespoon of pure aloe vera 5 times a day. Use bioptron lamp 2-3 times a day - that can't hurt.
I did take Belladonna pillules the first week, Amoxicillin 500 for 14 days, the nasal spray for 7 days then Sudafed for another 7. I'll return to nasal spray now if needed and might ask the GP for antibiotics to prevent sinus infection by all means. Until yesterday the stitches kept it kind of closed so sinus is fully exposed as of now, they appear clear yet.

I didn't talk much or have solid food since the extractions but had (all organic) juices and shakes made home from all kinds of vegetables and fruits, using almond milk rarely, water and coconut water. I don't smoke, don't drink alcohol or soda.
I rinse with sault water after every food (5), also used Corsodyl 3 times a day to prevent infection and clean the other teeth while the brush wouldn't fit in. I was given a syringe to use it on the holes. I know Corsodyl can slow down the healing but to none? I was told I needed it to keep infection off.
Now that I can brush (other teeth and tongue thoroughly and just pull the brush above the area very smoothly, no side movements there) I use Corsodyl in the evenings only.
I do not exercise, mainly rest - back to work on Friday.

Nothing else I can think of.
Thank you Bryanna, you've been helping more than you could imagine!
I'll try to exist with it and hope for the best. Felt a little pain since yesterday I think because it opened up.
Do you think I should go on antibiotics to prevent sinus issues?

Thank you so much,
Elna

ELna,

Thanks for sharing that information.

I really don't like the manner of which you have to see different dentists each time. That makes it impossible for someone to gauge the progress or problems. In the US, unless you go to a dental school or a multi dentist insurance run office, you will see the treating dentist every time. This enables the patient to be monitored more effectively.

I would not use the irrigation syringe in the oral sockets because that can push bacteria up into the sinus. So avoid that.

Perhaps you could benefit from adding a probiotic to your regimen. Supplementing with good bacteria helps to replenish and balance the intestines with healthy bacteria which helps the immune system to function better. It is essential to take a probiotic anytime you take antibiotics, have surgery, or any type of trauma. As a matter of fact, it is ideal for most people to take a probiotic every day of their life to maintain a healthy balance of intestinal bacteria. The one I currently take is called Custom Probiotics Adult Formula CP-1. I buy it online from pureformulas.com.

Without a proper diagnosis as to why the sinus is staying open, it is difficult to know what to do. Antibiotics should only be prescribed if there is an infection. Taking them preventatively is not really wise because not only do they alter the function of the immune system which can actually slow down the healing but they can cause certain infections to develop as they kill off the good bacteria that is essential to prevent infections in the first place.

I feel like you are in between a rock and a hard place because you have yet to have a proper clinical evaluation and reasoning as to why this is still open. I really wish there was a way to be seen by a private OS sooner than later.

I guess the only thing to do at this point is keep taking care of yourself, monitor your symptoms for any worsening issues, and pray that the sinus closes on its own. I know that is not real reassuring but without a clinical diagnosis, I don't know what else you can do.

Dear Bryanna,

Thank you so much for the advise again - stopped with the syringe and started probiotics.

Also went to the A&E. There was no OS on the premises but I was seen by a doctor who called one in the hospital for advise. In the end I was given more antibiotics and I was told to take it until they can see me in the hospital sometime next week, and that not to worry they'll fix this and they'll call me early next week for the appointment.

Also discovered what is the reason why my face feels not ok and can't smile all the way (even though the pulling of the eye is gone). Today had a look and found out that starting above my 4th teeth to the right, where they took the gum from for the second operation, the gum grew together with the upper front side of the inside of my cheek (probably during the first week when i could hardly open my mouth at all?), causing the movement restriction in the mouth and face.
I'm trying not to panic about this as I'm sure it can be fixed and I hope it's not a big deal. Better than if it was due to nerve damage, what I originally thought.
So next week they close the sinus hole in the hospital if not healed or at least much better. If it does heal, they can try to sort the gum - thing out I hope.

Unbelievable.
But on the positive side, I went to work today and it was ok, did the quite bits. And I don't know if it's because of the RC teeth gone, or the rest and the 2 weeks antibiotics, but my RHS seems to be rather better than worst - both balance and pain. :shocked: :smile:

Thank you again! I hope I can update with a happy ending soon.
Elna

ELna,

I am praying that you get a break from this really soon. Enough is enough already!! :/

I think you have been incredibly tolerant of all that has happened. I really hope that whoever you see at the hospital next week is going to treat this problem competently and with compassion. Don't be shy, let them know what you have endured and how none of the dentists that you saw were concerned about this problem. Sometimes there comes a time when we need to speak up for ourselves in spite of what the "rules" are and make ourselves be heard in order to be treated better. You deserve to be taken care of properly.

Regarding the attached gum/cheek tissue. It is possible that the dentist did that on purpose because he may not been able to get what is called "primary" closure over the open wound by just stitching the gum tissue together. This surgical technique is usually done on purpose if there is not enough healthy gum tissue to suture the wound closed. So they pull some cheek tissue over it. If that was the case, then he should have informed you about that. Be sure to show the OS next week and please ask for an explanation. Let him know how uncomfortable that is.

Glad to hear you are taking the probiotics. It is best to take them faithfully especially since you are on the antibiotics. Do not take them both at the same time as that would be counterproductive. Take the probiotic on an empty stomach either first thing in the morning or last thing at night. If in the morning, then take your antibiotic at least an hour after taking the probiotic.

I am glad to hear that work went okay!! :))

Try to continue getting rest, take good care of yourself and keep your optimism! Hopefully you will improve with each day and by this time next week you will be so much better :)

Bryanna

Dear Bryanna,
Hope you are well. Thank you for your last reply and help!
It is not over yet, not for a very long time I'm afraid.
Had the appointment at the hospital today.
They were nice, listened and cared, but in the end I was told that they'll try to close the (now 5x5mm minimum plus what can not be seen) perforation with the same method that failed twice.
If that will not work then they'll try the cheek thing you mentioned.
I asked her why do we think that the procedure that failed twice will have a different result this time and she said we don't know. Then I asked why we are not trying the other method straight away to which she replied that because if that fails there is no next step. Isn't this a bit weird logic?
I think it's about money - she has to try the cheaper before signing me up for the next one? This is local the other one is general anaesthetic.
I am really scared having anything done to the cheek because my smile is gone and the skin folds and pulls in between the mouth and nose already, I'm in constant discomfort and the gum and teeth on that side are not ok. I was told this cheek-involving operation will further narrow the mouth cavity on that side - I can not have that.
They said there is no point in touching the gum problem now, let's wait a few months to see how much it stretches and it still can be operated on if needed. It doesn't feel right though, my cheek starts straight above my teeth now on that side. But they are right I guess that fixing the perforation is more important, unless the constant irritation of the gum will not let it heal.
Do you think a palate graft could be done in this case? The first doctor said yes but they don't do it there the second one said it can not be used.
I know it is more painful but I much rather would have that one than torturing the gum further and would skip the trial - surgery altogether.
Would you tell me your opinion please?
Also, I know this is not a good question but don't you happen to know someone trustworthy in London UK? I'm prepared to finance all surgery myself if only I knew someone good and willing to do what's best for the patient (me). Please ignore the question if it is too much.
Regarding gum surgery - who do you think is the best to treat this problem? A periodontist would deal with it even if affects the cheek too?
Im sorry for firing questions again.
I was told to stop antibiotics now and I'm scared of adding serious sinus issues to the list.

She said the gum looks tender now and she'll operate when the inflammation went down. I asked what will cause it to go down (because I'm convinced that the pulling and stretching is causing trouble) and she said more time. But it's been more than 4 weeks already. I was booked for surgery for the 31st July, so I'll run around with a big hole for almost three weeks.
Do you think there is any particular risk to it or is it ok?

Thank you so much, again and again (and again).
Elna

Hi Bryanna,

I have added two pictures.
One of the gum looking like being connected to the face and hurtful when moving the mouth and another one of how the skin folds between the nose and mouth when smiling.
I was told just to wait a few months and it might stretch.
There is a chance for it to happen.
Doesn't the gum look like there's something really wrong going on there?
So sorry. Thank you!

ELna,

I do not personally know of anyone in the UK to refer you to. If I did I would have no problem sharing that information with you. The IAOMT organization has a listing of holistic minded dentists. Please check out the names on this link. Let me know if any of them are within a reasonable distance from you. If so, I can check out their website for information and usually I can gauge if they are legitimately holistic or not.

http://iaomt.org/find-a-doctor/searc...ist-physician/

Bryanna

ELna,

Thank you for posting the photos!

The photo of your upper right..... is this the side with the sinus that is still open?

Looking back at your panoramic xray..... your first molar on the upper right which is your 6th tooth from the front tooth and the sinus around this tooth does not look very healthy. If this is the same side that the sinus is still open, then the problem could be stemming from the first molar and whatever is going on with the sinus in that area. Has any dentist mentioned anything to you about that first molar and the sinus?

Yes, I agree the gum area in the upper right does not look normal... or real healthy. If there is a problem with the first molar, then this is what could be preventing the area from healing.

The line between your nose and mouth.... was that always there or just since you had the extractions?

Bryanna

Dear Bryanna,
Thank you for the link! I had a look but by holistic they mainly mean mercury - free and that's it, while promoting how root-canal saves the teeth. Will have a more thorough look later on - at the moment I'm in desperate search for an OS.
Thank you for having a look at the photos and x-ray again. I really think you are the reason I have not lost it yet :eek: :-)
Yes, the right side where the first molar looks bad is the same side where the sinus perforation is not closing.
Noone mentioned anything about the first molar yet. In fact, I had 3 doctors (dentist, OS) in the room at one point at the hospital, they were looking at the very same tooth on the new x-ray and laughing how funny one of the roots is stretching away. To the direction of the extraction site I must add.
I'm trying to get in to another hospital this week.
I would not mind at all having that one out too if possible so will not have to face this again.
No, the line between my nose and mouth has never been there before. It has sg to do with the now much smaller mouth cavity on the right side. I just want someone to fix the gum, cut it free from where it seems grown very close to the teeth now.
Thank you. Will update once there us a positive change!
:Thanx:

ELna,

A dentist who is mercury free would be a start because at least it shows his awareness of the toxicity problem with that issue. Also, holistic dentists who condone root canal therapy tend to be more open minded, as they are with the mercury issues, about the systemic risk of root canals than conventional dentists. Meaning they are not quick to tell their patient to have a root canal and they understand the jeopardy of retaining infected teeth. They have to be careful how they go about the topic of root canal because their conventional peers do not want this topic discussed in any way other than positive. A holistic dentist may be able to refer you to a like minded oral surgeon.

The way you are going now, you are seeing one similar minded dentist after the other. No one is addressing the first molar or the possibility of the connection between that molar and your open sinus. Even to repair that sinus, if the molar is in trouble, the repair won't fix the problem. Regarding the cheek tissue... that too needs to be addressed from a different perspective. It is not easy to just cut away that tissue and make the cheek flat again. Even if that is done, there is no guarantee that the line under your nose will change for the better.

Someone unassociated with the NHS or whatever it is..... needs to evaluate your situation because those in the system seem to be sticking together like glue.

If you take another look at that list and just let me know which ones are within a reasonable distance, I will review their website and give you my thoughts on whether they would be worth a try or not. If you think, that could be helpful to you............

Bryanna

Dear Bryanna,

Thank you so much for offering to have a look at the 'holistic' dentists London has to offer. At this point I need a good hospital but if the problem gets solved once I'll need a reliable dentist to deal with the damage being caused to my teeth right now.
There are three with a website:
http://www.w1dental.com/
http://www.adelaidedentallounge.co.uk/
http://theellaclinic.com/
Would you really have a look and tell me who looks the most genuine please? Thank you so much!

After my visit at the hospital on the 13th July and the promise of two operations and 4 surgeons declaring that there is zero chance for it to heal without operation, I decided I will grow the hole in by myself because there's no one I can trust with operating on me :)
Raised my vitamin c to 8000 a day, added 30 mg of zinc, used the bioptron lamp three hours a day and every awaken minute visualised the hole to be growing in. I imagined how at first the sides of it are just holding hands then folding arms then put their faces together until they're in full hug. I also imagined myself over and over being ecstatically happy finding out it healed. I also followed my (non-)eating regime. Spent a good amount of time crying and trying hard not to have a nervous breakdown.
Went to another hospital this Tuesday and doing the nose pinch exercise the surgeon could not hear air coming. My nose still gets wet while drinking and I'm quite sure I can not blow my face up (too scared to try), but he said that he definitely would not open this up and that I should carry on not sneezing and blowing the nose for another 4 weeks, watch out for sinus troubles for another 2 months, but that it seems to be healing now. He did not believe it was minimum 5x5 mm last week.
I do know it is not closed yet but at least I have some hope now. And time to recover emotionally for a while even if it turns out I would need the op in the end (no no).
My gums is an issue, it stretches and hurts. I was told by this surgeon again to give it a couple of months to stretch and get better but I think they're just not comfortable with doing anything about it and it does not seem important enough for them. But for me it's painful, uncomfortable and depressing.
I booked an appointment to see him: http://lukecascarini.com/
Next week. I will follow his advice on both questions. I'm not eating (I do get nutrition) anyway so might as well spend the money elsewhere.
About NHS - the extractions and the first two surgeries were all done at a private practice. Then I turned to NHS because it is the same chance to find someone good or bad as to go to another private. But then I decided to go for one of the bests as the outcome will remain with me forever and I'm only 38.
And if I was lucky enough to almost fully recover from total facial paralysis that RHS caused last year, I can not loose my smile and face on the same side just yet.

I'm sorry it looks like I'm writing a novel to you now. Thank you again for all your kindness, patience and help.
:hug:

ELna,

The ellaclinic would be my first and only choice based on the list you shared. That dentist is educated in the toxicity, toxicology and oral systemic connection which are huge PLUSES!! He makes emphatic statements about all of those issues and works with complimentary practitioners. He does perform root canals and uses a laser to help with the sterilization of the tooth. However, he also wants the patient to be well informed about the risks of root canal therapy and gives reference to that subject. He is into nutrition and full body health. YES, if you can, please seriously consider going to him.

The oral surgeon that you booked an appointment with seems very well versed on various surgical techniques. I think the one problem you may run into with most dentists that you see will be regarding the surgery that involved the cheek tissue. Most dentists are going to be a bit hesitant to mess with that because they cannot be sure what he did exactly and they don't want to end up taking the blame for any further complications. So it is important that when you approach this topic with any of them, that you do not sound like you are accusing the other dentist of any wrong doing. As that will cause further hesitation on their part. Just let them know that this is truly uncomfortable and you are concerned about living with this and what it can become. I hope I have explained that okay.........

Regarding the closing of the sinus perforation.............. I HOPE YOU ARE CORRECT and it is healing!! Yes, vitamin C is truly a miracle healer and antioxidant. However, it is imperative that you drink lots of water throughout the day because without adequate hydration, excessive oral vitamin C over a period of time can turn to little crystals in the kidneys. So drink water..... water.... water!!!

Bryanna

Dear Bryanna,
Thank you!!
I'll go see that dentist when the rest is over.
Yes, you explained very well how I might cause further hesitation. I will approach the topic the way you described it, without any hint of blaming anyone (even though I do). I hope the super-surgeon is confident enough and for a reason :-).
Yes, thank you - the one thing I forgot to mention is also PLENTY of water and some coconut water (pure). I think that's one of the reasons my sinuses are still ok.
Thank you Bryanna! :D (with slightly less teeth :) )

ELna,

You are always welcome :)

Okay good to hear about the drinking of water AND the pure coconut water..... excellent!!

I am a huge believer in vitamin C as I have seen it do miraculous things. I personally take a daily dosage of 4000 mgs of buffered ascorbate in powder form just for optimal health. If I feel a little fatigued or I'm around people who are ill, I take more.

Keeping fingers crossed that your sinus continues to heal and that you have better dentistry in the future!!

Keep us posted......:D

Bryanna

Dear Bryanna,

Hope you are well.
Update: I went to see the super-surgeon today.
There is still a hole but definitely got smaller again. He said he would not operate because there is a chance that it will close on its own and that sometimes they give it months not just weeks to heal. This is good, right?
He also said that the operation when they take the cheek fat (buccal?) would leave me bruised, unable to open my mouth for a while, further reduced mouth cavity and looking horrific for a couple of MONTHS.
Whatever happens I will not have this done. I rather leave with a tiny hole on the edge of sinusitis, seriously. Now I understand why the OS in the hospital wants to try the small operation first.

About the gum: he said if it will not get better it can be fixed but i should wait months maybe even a year for it to get better and that this is normal after an operation like that. I found out what the 2nd OS did: "... removed the perforated part and made a Wassmund-Rehrman-lobe, which I lengthened to the tooth 14. Closed it per primam with mattress and knot stitches. It was one of the most difficult sinus surgeries i have done" - that "lengthened" thing causes the trouble now. I wish he told me that it was going to be like this, I might have opted out. All he said was that he will take the gum from there and it will not be seen when i smile. He failed to mention that there will be no full smile but a lot of discomfort for quite a while though.

From what the surgeon said I gathered that might have been better if they just left it open at the very beginning. It might have healed and I would not have this pain and discomfort and looks. But both OS said it absolutely HAD TO BE DONE or else I would end up with serious sinus problem and big operation and trouble. They were obviously wrong, as 7 weeks this Friday, still open and thanks God nothing wrong with the sinuses yet. My RHS ear hurts a lot more lately though.

I am a bit desperate and scared at the moment.
One more month of just waiting around scared to eat or talk, feeling horrible every time the hole make a noise (when "eating"). The gum and the inside of the face hurts. And there is no need for 4th opinion, this is what it is.

I am sorry. I am really happy if I do not need an operation, of course.
Thank you, sorry, his came out just venting. Will update in a month. Thank you for everything!!!!

Dear Bryanna,

Further update: went back to the hospital today as I had the appointment booked for the surgery anyway and because she was willing to try the less invasive operation first before the buccal horror. She said the hole is much smaller but she would not operate anyway as it is still really red, we agreed in a month to see what happens.
I think the redness is a good sign - things are still happening there instead of having a fully healed permanent fistula, right?
Bryanna, last question and you will not hear from me until healed: do you know of any other form of sinus closing at this location (upper last molar) that does not involve further torturing my already so damaged cheek?

Thank you ever so much. :Thanx: :Head-Spin:

Update on my situation. Thank you for all the help again Bryanna. I'll update once in a while.

Last month: tried to heal, lost another 8 kg. Canker sores that I never had before appeared, healed, etc.

Went back to the hospital today. She said there's no way of knowing for sure whether the perforation is closed or not but as my nose still gets wet after I drink there must be still a communication. The site looks better but still red. I asked to wait another two months maybe it closes on its own she said ok. I didn't tell her that noone will operate on the fistula, I'll rather live with it from now on.

Do you remember how I was freaking out that something wrong was going on with the gum? Well, she said there's nothing that could be done to expand the oral cavity on the right side - now my inner cheek starts from right above my teeth 14-17, leaving me with a feeling of pulling on the right eye, pain when talking, ruined smile, a deep crease above the upper lip and not proper circulation in between the upper lip and the nose that leaves the area white and horselike. My speech is impaired, I thought it would get better but it doesn't and the stretching pulling either. She said the area can not stretch upwards so this is how it will be. And how I will be. I'm 38, lost my looks forever and cant talk normally - the sound of it is annoying, even hurts my own ears. She booked a consultation with another surgeon to see if it's worth at all to smoothen the surface with laser above tooth 14 - but she thinks not. On the left side the bone broke and the sharp bone piece sticking into my cheek will need to be done if does not settle - but that's nothing, I know.
ah yes and if as she thinks they'll have to close the fistula, the mouth cavity would get even smaller so I just won't have it done.

Also, there is no chance for implants on that side (that might be corrected, not easily though, if i wanted implants but I dont and wont).
It is absolutely sure that I'll never be able to wear dentures.
So let's just hope that I'll die before that - ergo pretty soon:rolleyes:

Now I understand why the super(expensive) surgeon acted the way he did, pretending it didn't matter but in the review he wrote he hopes it will become 'acceptable' - he knew I was done just didn't want to say it. Whatever.

Today the surgeon said that I could eat on both sides so I came home and had some soft bread soaked in yoghurt, goat cheese and just a bit of smoked salmon, finally. Washed my teeth, checked with a photo and the site is more damaged than before - the gum broke open a bit along the next tooth. I think it is from the pulling as I moved my mouth. So back to liquids and baby food (1st phase) for a while longer I guess.

I've booked an appointment with the dentist Bryanna you helped me choose and will sort out my bite and try if I can have a partial denture on the left side.

Right now I feel like I don't want to live any longer, with RHS PHN and now this, I'm blaming myself for not saying no to the second surgery and that's the worst. But tomorrow I'll pull myself together and start to learn to live with this too, it could be so much worst it's not a brain tumour or anything like that after all. I can live decades, a long, uncomfortable, shitty life filled with pain and loneliness, since noone will want to be in the company of someone who looks bad, sounds bad and feels bad all the time. Yeeeeeah. :cool: Only joking. I'll learn just not starting today. :)