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Oral Surgery/oral antral fistula


I got all four of my wisdom teeth removed on April 26th. They said the upper right was a bit difficult because it was impacted, so the next morning when I had a nosebleed I just assumed it was from that. About a week after the surgery once the swelling went down, I noticed air passing back and forth "like I could breathe through my socket", and when I would rinse with salt water it would come out my nose. I went back to the oral surgeon last Tuesday May 7th and he looked at my upper right extraction site and could see that there was a fistula there and he said he was pretty sure it would not heal on it's own. They scheduled me to have the flap repair on May 29th, and gave me antibiotics to start the day before the surgery. Right now I have pain in my cheekbone area, have been taking decongestants daily (I have horrible sinuses and allergies anyway) and in the last day have been having a very foul taste in my mouth.

I still have 2 weeks until the repair and/or antibiotics, is this going to be a problem or is this appropriate considering the fistula? My worries are that I was given steroids after the wisdom tooth removal to aid with the swelling, but I know they also reduce immune function and with this fistula I really don't want to end up with a terrible sinus infection.


Jamie - what you are enduring, with a secondary sinus infection, is not uncommon when an oral antral fistula develops.  For that reason, especially with an infection, it is important that the surgeon do more than just attempt to close the fistula.  The doctor needs to do two other minor procedures at the same time to arrest the sinus infection.  You will need, prior to the closure, both an oral and nasal antrostomy.  It involves making two holes into the sinus to clean it out and protect against sinus bleeding.  Once done, a closure of the fistula can be done more successfully.  Depending on the size of the hole into the sinus, a flap alone may not completely insure healing.  A thin golf metal plate placed over the hole and burnished to the bone will provide a water tight seal along with the gum flap.  I know you are not a surgeon, but I am telling you all this because you need to be aware of what should be done to insure healing.

The steroids given after the surgery should have worn off by now and should have no effect.  If you have additional questions, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired


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.


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

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

BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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