Friday, February 23, 2007

I have a sinus communication

(This isn't my mouth, my tooth had to be sawed in half, then broken, then twisted out....the result is a sinus communication in my case, WHICH my doctor didn't advise me about AT ALL)

Sinus exposure and oral-antral communication: This can occur when extracting upper molars (and in some patients, upper premolars). The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The doctor typically mentions this risk to patients, based on evaluation of radiographs showing the relationship of the tooth to the sinus. It is important to note that the sinus cavity is lined with a membrane called the Sniderian membrane, which may or may not be perforated. If this membrane is exposed after an extraction, but remains intact, a "sinus exposed" has occurred. If the membrane is perforated, however, it is a "sinus communication". These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure--depending on the size of the exposure as well as the likelihood of the patient to heal. In both cases, a resorbable material called "gelfoam" is typically placed in the extraction site to promote clotting and serve as a framework for granulation tissue to accumulate. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.

13 comments:

The todd said...

So... there's a hole between your mouth and sinus cavity? That's some crazy posting.

How long does this thing take to heal? Will it ever heal? If the sinus membrane is perforated, and there is no gelfoam, could you feasibly pass material through your mouth into the sinus??? I'm thinking... spagettini.

Sounds like a rough week for you She. Heal soon--I'm smelling coffee.

Sheyde said...

Well, I am told if the blod clot does its thing the hole should heal, although the chance is low. Yes fluid does go through it...I'm gonna find out if I can live with it, because to get it repaired costs more than my rent!!!! Besides me and that dentist will have words if this doesn't heal right!

I think coffee will be in order as well...just gotta get rid of a course and I think I will have time for it!!!

Simply Unpredictable said...

Ok, I'm going to ask something stupid.... how long did it take to heal to the point where fluid doesn't go through it?

The reason I ask something so stupid is I had a sinus exposure (or communication? I don't know which) with the removal of wisdom tooth #5 (labeled "1A") two weeks ago, and it's getting annoying feeling air come in through it, and have Listerine go up and out of my nose when I rinse.

diana said...

i have the same problem.just my dentist decided that the hole is not big enough and he stufed with plnty cotonwoll.the infection progress ,he change antibiotics but after one week all exploded in my mouth.i am still on antibiotics after aprox.a month. i use coton buds for ears dip in listerin 6 in 1 but the coton stick is not long enough to reach the top of the cavity.regular dentists study the site and advise me to go to a oral surgeon because this occrs very rare and they do not have the knoledge to deal with.my GP refered me to a oral surgeon whitch i will see in a month time.the worst part is when i talk becouse i cannot use letters 'P' and 'B'.any advece???

Simply Unpredictable said...

Diana -- give it time. After I made my post begging for info (which, alas, I did not recieve, but I am mostly healed now). I can give you 10 easy steps to help with the healing process:

Important step #1: Keep it clean. Ask for a syringe... One that you can bend a little to get into right angle to squirt Listerine up there. The cotton swabs aren't doing anything since it's not reaching.

Important step #2: Keep it clean. Don't use full strength Listerine. Water it down to about 50% strength, or less. And, the Cool Mint flavor tastes best watered down... and if a few drops comes out your nose, it's fine. You may also be able to get a prescription for ProDenRx, which is also a pretty good antiseptic.

Important step #3: Keep it clean. Rinse every time you eat, and any time you feel it's not clean. It doesn't hurt to rinse more often.

Important step #4: Keep it clean. Sudafed (generic is fine) will help keep your sinuses dry. Dry sinuses heal faster than inflamed sinuses. You'll probably want to be on this until the hole is sealed. I recommend the real stuff and not the "new formula" and generic is fine. There is also a nasal spray from Ocean that's just pure saline.

Important step #5: Keep the pressure down. Don't say the letters "P", "B", "M", or anything else that may change the pressure in your mouth suddenly.

Important step #6: Keep the pressure down. Don't smoke. Don't use a straw. Don't blow your nose. Don't pinch off your nose. Don't "sniff your snot down". Don't snore.

Important step #7: Keep the pressure down. When rinsing your mouth, don't close your mouth to swish. This increases the pressure and could increase healing time. Also, don't spit forcefully. Let the liquid "fall" from your mouth and wipe your mouth afterwards. Spitting is like saying a "P" and that's a bad thing.

Important step #8: Keep the pressure down. Don't sneeze! If you feel the urge to sneeze, push up on the bottom of your nose between your nostrils (kinda like you see on TV when someone stops from sneezing). If you sneeze, you risk rupturing the think barrier that develops.

Important step #9: Give it time. You're not going to instantly heal.

Important step #10: Keep it calm. Don't do strenuous exercise or work. That puts extra stress on your entire body and will take longer to heal.

There's no "instant bandaid" you can use. If the hole is as small as you say, it'll take a couple weeks before a thin barrier will develop. This is when you'll notice nothing is moving between your sinus and mouth. You're almost there. A few more weeks on this regimen will allow the barrier to strengthen up to where you can slightly blow your nose and start drinking thin liquids through straws (no milkshakes or smoothies). Your oral surgeon will probably tell you all this.

dizzycat said...

Thanks for this post and the advice. My daughter has a perforated sinus after a tooth extraction, we have been given little advice apart from not blowing nose or using a straw. The surgeon even suggested my daughter was imagining the sensations she has felt even though we were not told that this can occur and had not even heard of it! only after googling her symptoms was it that I discovered what had happened and contacted the surgeon the morning after surgery unfortunately by this point she had been huffing air in and out of the hole and drinks!! She has been given a five day course of antibiotics and no oral hygiene advice, should she be doing mouth washes? how long should I keep her off school? would a blow to her head damage any healing? sounds harsh but she gets bullied and this does occur. any advice would be appreciated.

Simply Unpredictable said...

to dizzy cat: Just try to keep everything in my previous post in mind during the healing process. Chances are, it'll take a number of months to heal. My oral surgeon kept me on antibiotics for the four months it took for me to heal -- especially after I got an infection during the brief time I was off of them.

Keep it especially clean. Mouth rinses are ok, provided you don't pinch your nose while you're rinsing. You WILL get whatever you're rinsing into your sinus cavity. Don't fret... just be a little careful.

If you're concerned, don't feel bad about going to an oral surgeon for a second opinion. They're more used to dealing with these than a dentist.

Baby~on~board said...

I just had a molar pulled and my dentist is also certified to do oral surgery as well. She informed me after doing an xray that the tip of my root was in my sinuses and there was a posibility that it could puncture my sinuses on the way out and she would have to put in some stitches to sew it up.

I'm glad she told me this before hand because it did happen. She pulled the tooth then held my nose shut and had me try to breath through it to see if air would come out of the whole where my tooth had been. She sewed it up and told me to not blow my nose or sneeze for 5 weeks, also to avoid spicy food. This was a week ago and my stitches have since desolved and I haven't had any problems. She put me on Zpac because I am pregnant and didn't want to risk me getting an infection.

She also told me that if I couldn't avoid sneezing, to leave my mouth open and this would help keep the pressure down. She told me that I wanted to avoid pressure in that area as best as I could. She also told me that I could use all the saline I needed to and that I could suck in through my nose but not to blow out. She also recommended decongestants to help ease the discomfort of swollen, irritated sinuses. But I can't really take decongestants due to health reasons so I just deal with a little stuffiness as needed and take tylenol when I get a headache from it.

I don't know how much help this will be since my doctor knew what she was doing and it sounds like the ones you all have gone to didn't know.

I don't know if it will actually take the whole 5 weeks to completely heal or what exactly will happen if I accidentally sneeze or blow my nose. I assume it will just take longer to heal.

I'm sure that the fact that she put in stitches helped a whole lot. I haven't had anything come out my nose since this happened, not even liquids.

I hope that everyone else heals quickly.

Freyja212 said...

I just had a sinus communication. At first something smelled really bad coming out through my nose. I tried to sneeze, then the air came out through the hole left by the removed wisdom teeth. I was scared, but the dentist who removed my wisdom teeth said it will heal itself, and gave me prescription of amoxicillin. I also followed his advise, but today I can feel the air coming out without sneezing, what should I do?

Atlantis451 said...

A few ideas. I just got a sinus communication and am planning my protocol.

1- Mouth guard for eating. Possibly supplement with a strip of knotted cloth between the teeth.

2- Immediate irrigation with iodine. Rinse after five minutes. Repeat for up to a few days. But no more to avoid iodine poisoning.

3- Neti pot for sinus irrigation. Also... irrigate sinus directly with an irrigation syringe. Just tip the head and it should go right into the sinus. So flow is sinus to mouth and not vice versa.

3- Xylitol and Lactoferrin to combat biofilm. Per "chronic wound" strategies. Which in this case is to avoid having it turn into a chronic wound.

Atlantis451 said...

Oh... also hydrogel. I just bought some DuoDerm Hydroactive Gel. Which is a hydrocolloid. Competitor is Carrington Carrasyn V. My plan is to inject it right into the hole. Possibly impregnate with Xylitol and Lactoferrin. Possibly thin if needed to get it to squirt out the syringe.

Also should be able to get an irrigation syringe from your dentist. An endodontic needle will do. 28 guage is too thin. 23 guage is a good compromise. But more like 20 guage is good for flowing a thick fluid.

Anchorage said...

I also have a sinus communication. I had a CT scan and it said I had an obstruction in the osteal meatal unit, that's the part of the sinus that drains to the nostril. Until that obstruction is corrected, the communication can't heal. The sinus fluid is taking the path of least resistance through the tooth socket. It is NASTY stuff. Oh, and I have a sinus infection, no surprise. Now it's steroids and antibiotics. If that doesn't work to clear the obstruction, it's surgery to clear the obstuction and plug the sinus communication.

Counsellor said...

Thank you Simply Unpredictable - I have searched for days and you're the first post I've found to acknowledge the "p", "b" and "f" pressure problem. Those letters send a sudden shock in the form of pain to my tooth, or rather the hole next to it in the gum leading to my sinus. I had an apicoectomy 2.5 weeks ago. My surgeon said I could go back to work in 1 or 2 days! Well, I'm an adult ed teacher (amongst other things) and with the sinus communication talking to a room full of people is just a nightmare! I'm doing all the rinsing, steaming etc. and the pain (read that as only when pressure happens) seems to get much worse after class and for the next day or so. I know it's early days but the hole is a fair size - I could fit a matchhead into it, it's plainly visible above my premolar. How long did it take before you could function normally?