Sinus perforated 3 months ago, not healed.

[ALGAL]

I had 2 rear upper molars surgically removed over 3 months ago. One of my molar's roots punctured my sinus wall. My surgeon said at the time it was approx 4 mm opening. It has now been over 3 months and I do not have closure on the opening. It feels almost as big as day 1 post op. My oral surgeon wants me to continue to wait for spontaneous healing, which of course I do as well, to avoid another surgery, however the opening is very stressful to me as it continually wants to fill with food particles and liquid & and risks infection in the area. It feels like there is a large pocket up in the area above the hole in my gum and I feel like I need to try to keep it cleaned out somehow but do not want to upset any healing. Should x-rays be taken? Is it practical & safe to continue to wait for spontaneous healing?

Thank you very much for any insight, and/or advice.

 

[Dr M]

3 months is a long time to wait. I don't know why the surgeon advised you to wait, since usually only 2mm openings and smaller spontaneously heal. A 4mm opening should usually be addressed as soon as possible, preferably on the same day the opening was intially caused. I would suggest seeking a second opinion from another oral surgeon. They will most likely suggest rinsing out the sinus, to clean out any debris, and then close the hole with a surgical flap. Don't wait any longer.

 

[ALGAL]

Thank you so very much for your reply and advice! My surgeon advised me immediately after the surgery that this perforation had occurred and that he placed stitches in it. Also sent me home with instructions how to protect the area, such as sneezing with mouth open, very gentle nose blowing, no straws, etc. On day 4 post op, suddenly I felt something had just happened, then had nasal bleeding and pain kicked in. Upon seeing him the following day & explaining this he seemed bewildered, just said we would wait now and watch it, never mentioned that I maybe had lost the blood clot and now had dry socket. So I powered thru it during all this time, seeing him a cpl times re infection concerns, etc. My current surgeon has many many years of experience & great credentials so I am very disappointed to be finding myself in this situation. Is this a difficult surgery to perform properly? And is it a difficult recovery for the patient?

I have read extensively about my situation and everything concurs exactly as you have advised. Only 2 sources (one I believe was NCBI) says to wait 3 to 4 months before referring for surgery. That is the only reason I have held out hope.

Again, thank you so very much for your time, concern and advice. It is very well taken.

 

[Dr M]

Usually the surgery is not too difficult to perform, and the recovery time afterwards is not too long either. It might be a bit more complicated since some time has lapsed, compared to performing the closure at the time of the sinus opening.

 

[ALGAL]

Thank you. Ideally, should my oral surgeon have closed it back up immediately (or soon thereafter) when on day 5 post op I told him something changed and that I now had bleeding & pain? He never mentioned that there was any reason for concern, and I didn't know that I had lost the clot & maybe was having dry socket pain. I do have appt for 2nd opinion next week.