Surgical closure of oral maxillo connection

2ndchance

Hi, hoping someone might be able to answer some queries please. I had last tooth right at back on top removed today under L.A. Procedure not pleasant, took quite some time with bits of bone stuck but had expected that as I have long roots and it has happened before. To cut a long story short, I needed some stitches and apparently there is now quite a large opening to sinus cavity visible. I have been given a letter of referral to the dental hospital which I will drop in tomorrow. What I am wondering is does anybody have any idea of what will need to be done? I have problems with sinus pain as it is and wondering will this make things worse. How long am I liking to be waiting for an appointment for something like this? I have private health insurance but dentist felt the dental hospital would be best. Many thanks for any help or advice.

Oral Surgeon

Sorry to hear OP,

Oro-antral communications are not pleasant but unfortunately happen...

When was the tooth extracted??

If recently, you can still allow it to close by treating the area very carefully;
No nose blowing,
No doing anything that results in a pressure difference between the mouth and nose, (blowing a balloon, using a straw, smoking, swimming, wind instruments etc)
Use sinus decongestants to keep the nose and sinus clear as gunk up there if infected could affect healing (vicks, karvol but don't snort them...!)
The dentist may or may not have you on antibiotics depending....
Warm salty water mouth rince and corsodyl/ kin rinse to keep the mouth clean and again prevent infection...

Closure can take 4 weeks or so...

If it heals but a communication remains- you need a surgical procedure to cut out this opening, mobilize the gum tissue and advance it to close the area. Again- you will need to follow all the instructions in the post-operative period to allow it to close...

It's a pain but step one, allow all to heal and then treat if necessary,

You will know that it is not going well, if you get fluid in your nose/ sinus when you have a drink, sinusitis etc...

Some dentists like to check if there is a hole just after an extraction by holding the patients nose and asking them to force air out..!!!!
THIS IS NEVER TO BE DONE JUST AFTER AN EXTRACTION as if there was a small hole that would have healed- you have not blown a massive hole in it and made it bigger, never ever ever...
It is ok to do this after a few weeks to check the area as any damage is already done and a hole can't be made worse, just identified...

Good luck,
OS

2ndchance

Hi, thanks for taking the time to reply. The extraction took place today. It took quite some time... The dentist when all the tooth was finally out, said I had a fairly large "hole" into sinus cavity. He then proceeded to hold my nose and have me blow through it although not very hard. He has given me a referral letter for evaluation at the dental hospital regarding surgical closure. He also applied surgicell and stitched the wound. I am prone to bad sinus infections at the best of times that literally take weeks to clear so dread getting an infection. I suppose I was hoping that I could just get this fixed now and have it over and done with rather than waiting as I've just started college today and don't want to end up sick. Thanks for replying.

Oral Surgeon

2ndchance wrote: »

Hi, thanks for taking the time to reply. The extraction took place today. It took quite some time... The dentist when all the tooth was finally out, said I had a fairly large "hole" into sinus cavity. He then proceeded to hold my nose and have me blow through it although not very hard. He has given me a referral letter for evaluation at the dental hospital regarding surgical closure. He also applied surgicell and stitched the wound. I am prone to bad sinus infections at the best of times that literally take weeks to clear so dread getting an infection. I suppose I was hoping that I could just get this fixed now and have it over and done with rather than waiting as I've just started college today and don't want to end up sick. Thanks for replying.

By all means, you can get it looked at sooner but depending on the appearance of the extraction site- it may be in your best interests to allow a period of healing as it is easier and more predictable for someone like me to advance and suture a clean healed gum flap than a flap of gum that is a little ragged and torn from a very recent extraction....

OS

2ndchance

Will bear that in mind. Thanks again.

2ndchance

Fast forward 6/7 weeks, couple visits to oral surgeon and hole appeared to have closed in. In last few weeks I developed fierce sinus infection (I am prone to them) which was worse on side of extraction, severe pain building up behind nose accompanied by pulsing type feeling in gum where tooth was. Just finished 10 days on flagyl and augmentin and ok for a couple of days. Feeling crap again though now and pain starting again. Had a look in mouth and looks like a blood blister on extraction site. What I'm wondering is if even if opening has closed in, could there still be a "pouch" or empty sack where long root was that is making sinus infection worse? I need to see someone again just don't know whether to go to GP, dentist, oral surgeon or ENT specialist. It's already cost me a fortune so want to get right person and get sorted once and for all. Would an xray show what's going on above gum or would a scan be needed
Thanks for any help.