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Oral Surgery/Wisdoms Extraction

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Question
Hi Sir,

I had all 4 of my wisdom teeth extracted under general anaesthetic 5 days ago. I was given the instructions not to blow my nose (he did not say how long, I assume until my post-op checkup 10 days after the operation itself) as the maxillary 3rd molars were close to the sinuses.

My mandibular 3rd molars had cysts growing around them, so I am awaiting a pathology report.
I had a mild nose haemorrhage a few hours after the operation, I am not entirely sure if that was a bleed or just excess blood that needed to drain somewhere. It was over within a few minutes. It was restricted to the right side of my nasal cavity, there was some blood coming from the left nostril, but the bulk of the blood drained through my right nostril). I have spent the past few days spitting up blood-streaked mucous (it's been slowly draining from my nasal cavity into the back of my throat#.

I am just concerned about my sinuses now. I accidently blew my nose because of hayfever a few minutes ago, but it is 10pm here and I can't phone my maxillo-facial surgeon. It did not last long, about 3-5 seconds, and it wasn't what I would consider a hard blow. However I can feel what I surmise is an air bubble lodged in my right sinus cavity and I am growing concerned.

Is it possible that I have ruptured my stitches? If not, how do I get the air bubble out of my sinuses without blowing my nose? What is the risk of infection at this point, both sinus and oral?

I have been rinsing my mouth according to post-op instructions #OroChlor mouth rinse x2 daily; salt + bicarbonate of soda + water after contact with anything per mouth, and before I go to bed), and following the dietary guidelines as given. I have also been taking antibiotics twice daily.

Thank you for your help.
Regards

Julia,
South Africa

Answer
Julia, Thank you for your question. No need to worry. It is possible that the stitched might have broken but after 5 days there is not a real concern. As long as there is no active bleeding, I would just take it easy and try to rest and not worry so much about it. The human body has a tremendous may of fixing itself and all we do as surgeons is allow the body to do just that. Get some rest. The possibility of an air bubble in the sinus is no need to worry. The sinus is normally filled with air so not easy to damage. Just try not to blow your nose and give your surgeon a call in the morning. Good luck

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon

Expertise

Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at www.eosdds.com

Experience

Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

Organizations
American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Publications
Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

Education/Credentials
S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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