Oral-Antral Fistual or Sinus Perforation? Advice? Experience?
 

Hi, everyone

I'm a 21 year male who got his wisdom teeth out in December of 2011, so it's been almost three years. After my gums had healed (so about two weeks later) I noticed that I would get this funny taste from discharge from the upper left corner of my mouth, one of the extractions sites. On top of getting discharge, I would get this smell in my nose that smelt like poop, facial pessure on my left cheek, and throbbing on my left cheek. I went to go see the oral surgeon that took the teeth out and he said he didn't see a hole and that's it common to have some sinus problems after wisdom teeth removal. He gave me some amoxciclyn and told me to wait it out.

It didn't get better after about another month, so I went and saw another oral surgeon near my university, since by this point I was back at school from winter break. This oral surgeon also said he didn't notice any hole or anything, but did a CT scan just incase. He said he found nothing on the CT scan and that things like this heal spontaneously.

Fast forward two and a half years and I still get discharge everyday, facial throbbing on my left cheek, the rancid smell in my nose, and when i close my nose and blow I can blow air (and sometimes the discharge) into my mouth. I got another CT scan a few months ago, so around the two year mark, and the oral surgeons still found nothing. The said i did have mucosal build up and a polyp, but they can't understand why it leaks out through the extraction site. They suggested I see an ENT and get am MRI.

I decided to go to ENT and told him my problem. He immediately said I must have some type of communication between my left sinus and my mouth, but it's a matter for the oral surgeons. In the mean time I got my MRI, which says similar things to the CT scan. I'm seeing another ENT soon and maybe he will be better help.

Does anyone have any advice? This problem has annoyed me for almost three years and I have no idea what next step to take.

Also
 

I forgot to mention that I do have a sinus infection in my left maxillary sinus. They found that after the second CT scan a few months ago.

Welcome frostyjohn. :Wave-Hello:

Hi frostyjohn,

I agree with the ENT that your symptoms may indicate a sinus communication which can occur when the roots of an extracted upper molar were in close proximity to the sinus. Sometimes the tooth is removed and the sinus membrane remains open because either the opening is large and/or bacteria is preventing it from closing. Usually the opening will close within a few months at the most.

When you explain your symptoms to the oral surgeons, what is there reply? Did the oral surgeon who did the extractions mention anything about a sinus communication when he removed the tooth?

I would bring a copy of the panoramic xray from the original oral surgeon to the new ENT so he can see what the area looked like pre-operatively.

I hope the new doctor is able to diagnose the problem. It does sound like a sinus communication associated with the removal of the tooth.

Please let us know the outcome.

Bryanna

Bryanna,

Thank you for your concern. What usually baffles the oral surgeons is that there is no obvious hole in my gum from where the fluid comes out, so they dismiss the possibility of an oral-antral fistula. I read somewhere, though, that the hoke could be as small a thread, which is my theory. That there is small in which saliva enters and keeps the infection going not let my sinus properly heal.

I have a significant amount of fluid come out of my gum everyday, so there just has to be some type of hole somewhere. It might not be the type commonly encountered, though, but there has to be one.

frostyjohn,

You are absolutely correct! The opening can be the size of the head of a pin. Your symptoms are connected to something abnormal so you need to keep searching for a diagnosis. I'm sorry the oral surgeons have not been helpful. Could you try to locate an oral surgeon who is also an MD? Sometimes the surgeons with the dual degree, DDS or DMD along with an MD, are better diagnosticians.

Hopefully this will not go on much longer... hang in there!
Bryanna

Hi. I am a dentist and the advice given by Bryanna is good info. Finding the communication or "oro-antral fistula" is pretty easy. You just have the patient hold their nose closed and create back pressure. Fluid will flow into the oral cavity and be easily seen.
Correcting this problem requires a sophisticate and skillful surgeon. The procedure involves opening the the gum tissue adjacent to the opening and then sealing up with a membrane, usually one that dissolves or resorbs with time. The problem is that the maxillary bone in that area is delicate and thin which makes healing unpredictable. It may take more than one try.
Your best bet would be to go to a dental school and show them the problem. You just might find a good and ethical practitioner who is willing to give it the time it needs.
Hope this helps and good luck
Topgum

Hi,guys

I just saw another oral surgeon today and he said that there is absolutely no hole based on my ct and mri scans. His theory is that the fluid comes from my throat and collects in the left gum extraction site. Has anyone heard of this happening? I just dont see how the fluid can come from my throat and make it all the way up into my left gum pocket area.

I can close my nose, put pressure and SEE it bubble out of my gum. Although a lot of pressure is needed. But the oral surgeon today said that for the amount of fluid i say that is coming out, there has to be a larger hole.

We both agree though that there is a polyp and i have a sinus infection. The polyp needs to be taken care of and i think will help reduce the sinus infection that creates the nasty fluid. But will taking care of the poly stop the fluid from flowing into my mouth?

I'm seeing an ent on wednesday,

When i create back pressure, i can see the green fluid come out. It comes out slowly and i have to create a lot of pressure, and some times it doesn't come out at all, but it definetely comes out from that spot. Some days I can even feel it "squirt" out from that area on it's own.

I try not to create back pressure too often out of fear of making it worse.

How much do you buy this surgeon's theory that it comes from the throat and collects in the extraction site? I just don't see how it would "climb" into the spot and collect in the extraction site.

frostyjohn,

I think you went to a blind oral surgeon. Seriously......!

Perhaps the sinus infection is draining down your throat and when you pinch your nose closed then the build up from the applied pressure brings the crap up from your throat. But why it lands in the extraction site and comes out the invisible hole is beyond me!!

If the polyp is correlated to the infection that was coming from that tooth then perhaps the polyp is actually where the communication is...??? Still does not explain the stuff coming out of the invisible hole though.

By any chance has any of these dentists taken a periapical xray of that area? Sometimes a communication will show on that type of xray... even really tiny ones.

Bryanna