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Oral Surgery/Bridge after OA fistula and sinus cyst

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Question
I had oral surgery almost a year ago and had tooth #3 extracted, which was previously covered with a crown.  The original plan was to do a sinus lift and bone graft and eventually an implant to replace #3.  During surgery, it was discovered that I had a rather large cyst in my right sinus (had no previous sinus symptoms).  Subsequently the cyst and infection were removed but the bone had eroded due to the cyst so an implant would not be an option.  Approximately two weeks after surgery, I woke up and the entire right side of the roof of my mouth was swollen down to my tongue.  Returned to oral surgeon and was discovered that there was an OA fistula that had pooled infection in the roof of my mouth instead of out of my sinus, and the cyst had reformed.  An additional debridement was done and additional mesh was placed.  It healed nicely and I did not have additional problems.  I was cleared by my surgeon approximately three months ago when he stated the fistula was closed and I could proceed with my bridge.
Went back to family dentist who prepped #2 and did root canal and crown prep on #4 and additional root canal and crown prep on #5 to replace old large fillings.  He placed a temporary bridge that also had the temp crown for #5 joined to it.  He stated at the time that #2 was "tilted" and he was having a hard time with the impression and temp bridge fitting.  That was over 2 weeks ago that the temp bridge was placed.  For a week I had extreme sensitivity and tenderness on #2, which has somewhat subsided but it still significant for hot/cold. During the crown prep/temp placement, I received an injection in the upper right which caused me to have extreme double vision for nearly 20 minutes.  I felt a hot pain and watering in my eye immediately upon the injection and it didn't subside for what seemed like a long time.  The dentist attributed it to a drop in blood pressure, but I feel strongly it was not that.   My main concern is that I have had tremendous pressure in the right sinus again after the most recent work.  I am hoping it is not because the fistula was still open and is now covered by the bridge.  Needless to say it has not been a fun experience, and I am frustrated and hoping for some additional information.  I am unclear what to attribute the pain and pressure to since so much has happened.  Thank you so much in advance for any insight that you may have.

Answer
Jamie - It is a little difficult to be sure without seeing xrays from three months ago and new ones.  If new bone had not completely formed throughout the area of previously lost bone, only soft tissue was separating the mouth from the sinus in some locations.  These areas without full bone formation would allow a simple dental injection to place the numbing fluid into the sinus.  If so, the double vision could definitely be caused from the injection.  The fistula may be closed, but the lack of bone could be a site that needs to be careful for injections.  You need to contact the surgeon and let him know and have him have you examined for bone density reformation.  I hope it is only a small spot where the injection was given.

Oral Surgery

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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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