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Oral Surgery/Blocked Ear and Swollen Palate after Sinus Lift

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Axial View Sinus CT Scan
Axial View Sinus CT Sc  
Coronal View Sinus CT Scan
Coronal View Sinus CT  
QUESTION: Dear Dr. Teig,

I had a sinus lift surgery done on my left side on early April. The surgery was fine. I had some blood from my nose for few days. In the next week, I had strange wind from my mouth to the nose, but that disappeared 2 weeks later.

But on 3.5 to 4 weeks after surgery, I developed sever allergic reaction with waterly running nose and drainage to my throat. After that my ear was blocked and it was so bad that I had the graft taking out on end of May.

In between I have taken 35 days of Augmentin.

Till today,  I found  my left ear was very easily blocked. In the night, I feel that the end of left Eustachian tube was blocked from something inside my mouth. It keeps me wake.  The left palate was swollen. My left throat is a bit of pain when I swallow. My left head was very heavy. My left neck has grinding and popping sound.

I am taking another 10 days course of Augmentin 5 days ago. But the situation doesn’t seem to get better. I am seeing my ENT.

Is it infection or irritation from the surgery? What should I do?

I attach some CT scan.

ANSWER: Lily -  It is obvious from the films you provided that there is fluid retention and swelling of the internal tissues within the sinus. Without a direct exam I cannot be completely sure, but there is an obvious blockage of the sinus fluids draining completely into the nose.  The Eustachian tube enter the nasopharynx.  If there is inflammation of the nasopharynx the Eustachian tube is often blocked.  It is obvious that you are suffering from a sinus inflammation or infection that has produced all you symptoms.  The strange wind from the nose is most indicative that you have suffered from an oral antral communication, that was most likely caused by your surgery and produced your problems.  

Seeing the ENT is important.  He needs to discover if a communication is still present.  I wish you well and hope the ENT is familiar with this situation.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Teig,

I went to see my dental surgeon and asked him to check if there is oral antral communication. He looked at my mouth and said everything healed very well, no OAF seen. He told me that it took time to heal from surgery. He even said all the pains or discomfort maybe from my mind. It has been almost 2 months after my second surgery. I feel if nothing is wrong, things will heal by now.

I took antibiotic Augmentin for 13 days now and upper palate swollen and throat head pain are much better. But today, I found yellow with blood discharge coming through my throat from somewhere the end of Eustachian tube is and upper soft palate.

Can I check myself for the OAF? Is there any possibility that sinus fluid is leaking to gum that cause throat and soft palate swollen and Eustachian tube discomfort even without an obvious fistula?

Thanks,
lily

Answer
Lily -  The only check that you could do would accentuate the OAF.  It is difficult for me to give you an appropriate answer without a direct exam, a CT scan and or an MRI of the area.

A swollen palate can come from an OAF or just some sinus inflammation. I wish I could give you a more definitive answer, but more information is needed.  

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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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