You are here:

Dentistry/Dentigerous cyst-unerrupted wisdom tooth

Advertisement


Question
Dear Sir,
2 years back My daughter, 20years age, had swelling around right upper jaw. She was treated by our family Dentist, removed and cleaned the abscess and given antibiotics.
A typical problem started after about 6 months. She started noticing fluid in her mouth and accumulation in a small quantity every morning. It had a foul smell but did not cause any pain. Dentists took out X-rays but could not see anything and the problem remained undiagnosed.
A month back when The Dentist took out Xray scan (OPG) which revealed an unerrupted wisdom tooth with the crown pointed upwards with no space in the jaw for the wisdom tooth to erupt and darkish area indicating infection, Dentist said it's Dentigerous cyst and wisdom tooth must be extracted. Dentist performed oral surgery to extract the wisdom tooth. While reaching to the wisdom tooth, Dentist had to cut / drill the bone to create access and came across abscess pool in the dental bone. This was cleaned. This much process took nearly 2 hours. However, the surgery was stopped without extracting the Wisdom tooth as it was too much close to the sinus and also chance of rupturing the blood veins. Further cutting of the bone to extract the tooth was avoided as it was risky.Surgery concluded with 5 stitches which were removed after 1 week.One week's antibiotics was taken.
Now, there is no pain and no swelling BUT there seem to be a problem. While gargling with warm salt water, the water came out of right nostril (water was not swallowed). My daughter feels pressure around the operated area whenever she tries to blow air by mouth (like blowing the candles on the B'day cake). She is afraid to sneeze fearing rupture of the operated area.

Doctors have said 90% chance that infection (cyst) will not recur, Wisdom tooth will change the course and erupt from the space created by drilling/cutting of bone and called us every month with OPG scan for review.

Sir, My question to you is
1. What is happening to my daughter.
2. Has sinus got ruptured during the surgery and therefore there an opening from the jaw bone to the sinus.
3. Is it normal, will it get healed on it's own
4. Will the cleaned up cyst recur.
4. Is another surgery required and is it going to be complicated.

Awaiting your reply with advise.

Thanks and Regards,

Maqsood

Answer
Magsood - Well, of course, without examining her or seeing an xray of the area I cannot be completely sure, but from your description, she seems to have an oral antral fistula.  This is a communication between the mouth and the sinus.  This communication obviously began in the surgical site and still is present there.  

It is not a rupture of the sinus, but the doctor who drilled into the bone created a pathway from the socket he was cutting through the bone, through the schneiderian membrane that lines the sinus and into the sinus.

Will it heal?  That is a little difficult for me to answer; not seeing the opening.  They can occasionally heal on their own, but your daughter cannot blow her nose.  If she sneezed it must be done with her mouth open to prevent internal pressure in the sinus.  It may close if it is small.  If, however, the opening is relatively large, it will not close.

If not all the cystic material was removed, then the cyst could recur.

Another surgery might need to be done by a skilled surgeon, who is knowlegeable about the sinus and the mouth.  It is a technically difficult and exacting procedure and the most important factor is creating a water tight seal between the sinus and the mouth.  Since fluids from the mouth, that contains bacteria naturally, flows into the sinus there will be sinus inflammation and possible infection developing.  For that reason the sinus often needs to be cleaned, during the surgery, before the opening is closed.

So she will need a skilled oral and maxillofacial surgeon and possibly a skilled ear, nose and throat doctor (ENT) specialist to evaluate and possibly treat.  Getting the best doctor is the most important factor to close that opening as soon as possible.

I wish you well and your daughter well.  I hope you can find the appropriate doctors to help.

Dentistry

All Answers


Answers by Expert:


Ask Experts

Volunteer


Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

©2016 About.com. All rights reserved.