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Oral Surgery/Oral-sinus communication

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Hi Dr. Teig,
Eight months ago I went to the dentist to have a crown put on an upper right side molar 2nd from the back.  When the dentist prepped the tooth for the crown the nerve in the tooth was irritated and didn't settle after a week.  I saw him again for an emergency root canal.  10 days later I had the permanent crown put on but as soon as the freezing came out I wanted to shoot off my own face....never felt pain like that before.  3 days later I saw my dentist and he extracted the molar.  It turned out that one of the roots had cracked and the tooth couldn't be saved.  For weeks following the extraction I had such pain and pressure in my jaw I could hardly stand it. 5 weeks after the extraction I saw an oral surgeon who performed emergency surgery to remove sizable pieces of dead bone and to debride the extraction area.  Within days of that surgery my right nostril started feeling like a wind tunnel.  Air going into my nose felt like an icy cold burn.  I developed a sore inside that nostril along the cheek side and in a place where I couldn't see it.  It bled for 3 and a half month.  I would touch it with a Q-tip...honestly not poke or dig...just touch the area and the Q-tip would be saturated with blood...I would go through a dozen before the bleeding would almost slow.  Sometimes I would use a little peroxide and would feel it bubbling above my tooth root and into my cheek.  I thought that would help it heal but it was so painful.  I mentioned the sore and what I felt was some kind of oral-sinus communication to my oral surgeon who said what was going on in my nose had nothing to do with the surgery he did.  I saw an ENT who examined my sinus and said it looked fine but he did not examine the sore as the day I saw him I had put a white antibiotic cream on the sore. I told him what was going on but he completely ignored it and there was nothing in his report about that area...which was the sole reason I went to see him.  He couldn't be bothered to clear the cream away and check out the area.  Horrid experience.  
Since then I have been in constant pain with my right cheek always slightly swollen.  I took a variety of antibiotics for 15 weeks because no one knew what else to do.
Today I had a second emergency oral surgery because I had what I felt was a massive plate of exposed bone coming out of my jaw.  The oral surgeon who performed my surgery said that the bone was not loose but inflamed.  He did a skin graft over the area in hopes that it will help. My teeth along the right side have sudden recession as well.  Within 3 days the gums have receded almost to the top of my jaw.  The oral surgeon initially thought that he would have to extract 2 teeth but when I woke up they were still there.  This story could go on forever.  I have had an MRI, 2 CT scans, numerous sinus x-rays, dental xrays including panoramic and I-scan and nothing has shown up and there is still no explanation as to why my gums seem to be melting away and why my sinus and cheek burn so much. Is it possible that there is a communication between my sinus and jaw/cheek that any of these tests just wouldn't show? I don't have sinus infections and sinus is not congested.  It's the opposite of congested as it feels like a gaping hole and that when I breathe, I'm breathing into my cheek.  Absolutely nothing stops the pain.  I have also seen a neurologist who has ruled out any neuralgia.  I've seen an oral pathologist who prescribed and ointment to apply to my gums but that didn't help.  I do have another appointment with a second ENT scheduled for 2 weeks from now.
I am at a loss as are all of the doctors, dentists, surgeons, radiologists I have seen.  The pain is real.  The swelling is real. And I have had my head examined enough times in last 8 months that I'm sure I'm not crazy.  Could an oral-sinus fistula possibly cause all these problems without causing a massive infection?  One more thing....Following my initial oral surgery 7 months ago I felt something hard up in my nose. I looked up my nose with a flashlight and saw what I thought was a stitch with a cluster of knots on the end.  I could feel it poking my nose and I could see it.  Within a couple of days the stitch moved out of sight and that is when the sinus/cheek pain started. I asked the surgeon who said that the surgery had nothing to do with my nose and there wouldn't be a stitch there....but I know I saw it. Is it possible that there was a misplaced stitch that tore it's way through my sinus. Would a dissolvable stitch show up on xrays?  I swear I saw it and I could feel it.
(And honestly, this is only part of the my story...)
Thank you for any insight you might have.

Answer
Terri   -  Wow - this is a tough story.  I feel so sorry that you have endured all this discomfort without a valid reason for it.  A hole into the sinus can definitely produce secondary effects such as an infection, but that would show on xray.  A single stitch should not be enough to produce the excess problems you have.

You don't say if you are taking any medication presently or before the procedure for the prevention of osteoporosis.  If so, that is a possible cause.  Other than that and without examining you, I cannot be sure.  

I don't know where you live, but I suggest that you go to a medical center where there are a significant number of skilled professionals and specialists that would be best to define your situation.  Sorry I could not be more exacting.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon 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 practicing for over 20 years. Assistant Clincal Professor at 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 Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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