Oral Surgery/Wisdom tooth removal
QUESTION: I had three wisdom teeth removed (2 upper, 1 lower) 10 days ago. Prior to the surgery I was aware that I had a retention cyst in my right maxillary sinus. After the surgery I had bleeding in my sinuses. Three or four days after surgery the 99% of the bleeding in my sinuses stopped, but I developed severe pressure in my sinuses along with an unforgiving headache. I had been on amoxicillin for 5 days. I started augmentin on day 6. I have been resting, steam showering, taking Sudafed and Ibuprofen every 5 hours. On day 7 I visited the surgeons office. To mg dismay he was out of town doing surgery and running late getting back. The other surgeon that was in the office did not build my confidence. He squeezed my nose and told me to blow to see if air came out of my mouth. It did and made me very dizzy. That seemed like a bad idea to me. He did a CT scan in his office and told me that my right sinus was "obliterated". After a million things went through my mind in 2 seconds he showed me the images and my right sinus was packed full of stuff. He said it wasn't a watery fluid like blood because there was no separation line on the image. I asked if the complication was due to my existing retention cyst. He said he didn't know because he couldn't see anything due to my sinus being so full. Only my maxillary sinus cavity was affected. All of the other sinus pathways were not involved. I am still experiencing sinus pressure although it seems to be lessening, however the headache seems to keep coming back. I had a traumatic experience as a child that has made me somewhat paranoid in situations like this. Half of the battle for me is always mental. My question for you is how likely is it that I will have some kind of permanent damage to my sinus that cannot be fixed and will leave me with headaches and sinus problems forever?
ANSWER: Dave - Any continuation of a problem in the sinus is based on addressing the cause. It sounds like you still have an opening existing between the sockets and the sinus. This opening allows saliva from the mouth to gain entrance into the sinus. In saliva there is bacteria and allowing the saliva to gain access to the sinus allows for inflammation and or infection of the sinus. This is not good and the opening between the mouth and the sinus (called an oral antral fistula) needs to close on its own or surgically be closed. Without directly examining you I cannot be sure, that is occurring, but until the opening into the sinus closes on its own, which if it has not occurred 10 days after the surgery, it might not. Then surgical closure might be necessary. So you need to have this addressed by the surgeon who did your extractions soon, before the sinuses become infected. Because there is still and opening, you should be on antibiotics to fight he development of an infection. This is probably what is producing the headaches.
---------- FOLLOW-UP ----------
QUESTION: Thank you so much for your response. I should add that when the oral surgeon pinched my nose and told me to blow he did not think any air was passing through to my mouth from my sinuses. I felt it and told him so. That's when he had me do it again and he could tell the second time. To better describe it, it was a very small amount of air and this was on day 7 post surgery. If I go in tomorrow, day 10, is it a good idea for him to hold my nose again to test for air passage, or is there another way you would recommend? I would also add that today has been my best day so far as the sinus pressure is almost completely gone and the headaches have stopped.
Thanks again for helping a complete stranger out of the kindness of your heart.
ANSWER: Dave - Since the symptoms are beginning to resolve, I would suggest that the doctor does not attempt to see if air is leaking when you blow. These openings can heal quickly, if they are small and a lack of pressure is applied to the opening. I would suggest to allow his to evaluate you, but avoid the blowing unless the sinus problem resumes.
I hope it heals quickly and nothing further needs to be done. Best of luck.
---------- FOLLOW-UP ----------
QUESTION: So, this Friday (14 days lost removal) I went to see the Oral Maillofacial Surgeon who did the procedure. He had a look and listened to everything I had to say. I am of the impression that he is very good at what he does (12 years post residency). He said everything is healing great. He said the small amount of air that came out of my upper tooth hole was not a big deal and that it would heal on it's own. I have been feeling better every day to the point that today I woke up feeling 95% good to go. Fast forward to a couple hours ago, driving down the road on a road trip, after we stopped for snacks, I was trying to rinse my mouth with water after eating some pretzels and I was swishing it from one cheek to the other under a small amount of pressure and sure enough a little water came right up out of my nose. I immediately texted the Surgeon and he said it would be OK and to stop swishing with pressure. He is very quick to help me and seems like an amazing Surgeon. I've read that after 10 days this kind of thing doesn't heal on it's own. My question is, because of the small size of this opening and my board certified Oral Maxillofacial Surgeons'opinion, does that make it possible to heal past the 10 day mark?
Dave - if the opening is very small, the opening may heal on its own. At this time, the area is fragile and any rinsing that gains entrance into the sinus might keep the area open. So the surgeon is correct that you need to be careful. No blowing of your nose, if you sneeze, do it with your mouth open.
I hope that the area begins to heal on its own, but if by another two weeks has passed, the surgeon may have to take a more active approach to closing the area. Don't stimulate it or place anything into the opening and hopefully it will heal.