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Oral Surgery/oroantral communication


HX: removal of #14 reveals 3-4 mm oroantral communication. Tooth was completely removed. No fractures or tips left behind. Gel Foam packed. No sutures.  Pt was given sinus precautions, antibiotic, Tylenol cold and Flu.
Pt followed up after 1 week. At which time pt reported pressure pain and feeling of air and water in the sinuses with air conditioning and brushing teeth.  Clinically soft tissue has started to heal and socket has small slit opening 3-4 mm. Gelfoam was placed again.  Patient phoned clinic to say gelfoam had fell out before he got home. Pt followed up by phone next a week later (2 weeks post extraction) symptoms the same.  What timeframe should I allow for healing before referring pt to oral surgeon.  I have no experience with buccal advancement flaps and I do not plan to start now.

With a small opening of this nature. Just inform the patient that it will usually close by itself. It may take 6 months to fully close. Avoid nose blowing and straws for that time. No need to place anything in the socket at all. Have her follow up in 8 weeks and take a will most likely be closed. After 8 months if not healed, consider sending to OMS but if continues to get smaller, just keep an eye on it.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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