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Oral Surgery/Wisdom tooth extraction spreads to sinus


My 26 yr old son had a wisdom tooth removed 6 weeks ago due to infection. It turns out the antibiotics prescribed were about 50& the strength required to kill the infection. In summary the infection has spread to his sinuses and destroyed one of his cheek bones (malliofaxical?) He has been to dentists, oral surgeons, an endodontist, periodiontist, and now an ENT specialist. The ENT suggests a CT scan of the head and culture sampling, then probable surgery to rebuild the bone that is gone. This will require skin graft.

Is there something my son should ask to ensure he has been properly diagnosed? And do you know/recommend a top ENT surgeon in the CHICAGO area to do the surgery if possible?

I am grateful for any guidance you might offer.

Leslie -  First -  I do not know an ENT doctor in Chicago, area.  Sorry

I don't know what you've been told as to the cause, but, and of course I cannot be sure without see preoperative xrays and postoperative xrays, but it sounds like your son suffered an oral antral fistula.  Simply, the roots of the tooth involved were in close communication or actually entered the sinus.  In such an extraction the surgeon needs to be extra careful in the surgery and if an opening into the sinus does occur (whether the extraction was done properly or not)the surgeon needs to immediately address the opening and attempt to close it.  Your son should have been examined and followed every few days after the extraction if the opening was present to see if the opening remains or does it heal on its own.  If the area remains, the surgeon needs to attempt to close the opening and do an oral antrostomy.  That procedure involves making a hole into the sinus from the mouth. clean the sinus and close the opening.  Secondly, the surgeon should have created an airtight closure of the opening by one of a number of different procedures (the type of procedure is based on the size of the opening, position and surrounding stable or lack of stable bone).  At this stage, an appropriate dose and appropriate antibiotic is given.

Other treatments might have needed to be done immediately or soon there after, bit, of course, without seeing the surgery or after stage, I cannot be exact or correct as to what was necessary.

I hope the ENT can properly quell the existing problem and makes sure that health of the area will be present.

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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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