Oral surgery :: Perforation of the maxillary sinus

The maxilla, translated from Latin, is the upper jaw, and the maxillary sinus is a cavity in the upper jaw. Perforation of the maxillary sinus is a very common complication in the extraction of the upper teeth. There are anatomical preconditions for this. The tips of the dental roots, from the upper 3rd tooth to the upper 8th (sage), are very often close to the floor of the sinus or separated from it only by a thin bone wall, and sometimes only by the sinus mucosa. Naturally, when a pathological process (granuloma, cyst) develops around the tip of the tooth, which necessitates its extraction, it is quite possible, even with exact extraction from the dentist, to break this wall or tear the sinus mucosa and form an opening. sinus and oral cavity connection - perforation. Therefore, the extraction of the upper teeth must carried out in an appropriate manner, carefully and with the necessary responsibility. In any case, we need to have an x-ray that will help us determine the proximity of the root tip to the sinuses and whether there is a pathological process. Any self-confidence and rudeness can be fatal.
What happens when we perforate the sinus after extraction?
From the wound begins to "whistle" air, passing from the sinus to the oral cavity and back. If the patient drink water, it passes from the mouth into the sinus and exits through the corresponding nostril. The tone of the voice may also change. Therefore, the dentist must perform a test. It done by grasping the patient's nose with his thumb and forefinger so that he closes and asks the patient to blow through the nose. This results in a strong whistle of air coming from the sinus through the wound from the extracted tooth to the oral cavity. We say the nasal sample is positive. This is a sure sign of perforation of the maxillary sinus. However, the nasal sample may also be negative - there is no air leakage from the wound when applying the technique described above. This does not always mean that there is no perforation. The negative nasal sample (except when the sinus is not really punctured) is due to the formation of a kind of valve of an inflamed sinus mucosa, which obstructs the perforation opening and prevents air from passing through it. In this case, the wound from the extracted tooth should carefully punctured with a special probe, and if there is no perforation, the probe will stop at the bottom of the alveoli (holes in the jaw at the location of the root of the extracted teeth). Conversely, if there is a perforation, the probe will pass freely through them and sink deep into the sinus. This can also documented with an x-ray.

What should the dentist do after finding sinus perforation after tooth extraction?
First - to maintain self-control and explain to the patient what happened and why, as well as to reassure him that the condition is treatable.
Second, the dentist should tampon the wound from the extracted tooth. He should put tightly in the wound, specifically for this purpose, a gauze that is soaked with appropriate medicines.
Third - to give the patient instructions for the postoperative period. If all this does not happen, ie. if the dentist does not detect the perforation or worse, if he or she detects it but does not inform the patient and take adequate measures so that the perforation is closed, a serious opening is formed, which ensures continuous communication of the oral cavity and sinuses. This leads to a number of inconveniences for the patient - impaired diction, passage of food and water from mouth to nose, chronic sinusitis with unpleasant odor to others, embarrassment, even making impossible social contacts ... And since the maxillary sinus has a direct connection with others sinuses in the skull, they also become infected. This requires a specific operation to close the sinus communication. We bring to your attention a series of photographs illustrating the steps of this operation:
    1. An old perforation
    2. X-ray of the skull, on which no sinusitis is observe
    3. State immediately after surgery - lateral view
    4. The same state - bottom view
    5. State one week after surgery - the steches are downloadable
    6. State after removal of the sutures - the surgical wound healed



Here is a scheme of the operation


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