Addressing Sinus Perforation After Tooth Extraction: Surgical Options Explained

The doctor interrupted regarding the issue of maxillary sinus perforation during surgery?

Hello Doctor, two years ago I had a tooth extraction that resulted in an oroantral fistula, which has not healed since.
I often experience headaches, and the key issue is that the site of the fistula is covered by a fixed dental prosthesis.
I would like to ask if surgical repair of the defect and sinus debridement necessarily requires the removal of the prosthesis.
I have been wanting to undergo surgery for treatment, but I am concerned that removing the prosthesis will cause damage and I would have to redo it, which is too expensive.
I appreciate your clarification.
Thank you.

Azhong, 30~39 year old female. Ask Date: 2018/10/15

Dr. Lin Jiayong reply Dentistry

Hello, you did not mention the relative position of the oral fistula to your dentures; however, I believe you have had relevant discussions with your dentist.
The surgery should have its importance and necessity.
If economic factors are a consideration, you and your dentist can discuss the materials for the dentures.

Reply Date: 2018/10/15

More Info

Addressing sinus perforation after a tooth extraction is a complex issue that requires careful consideration and often surgical intervention. Sinus perforation can occur during the extraction of upper teeth, particularly molars, due to their proximity to the maxillary sinus. When a perforation occurs, it can lead to various complications, including chronic sinusitis, persistent pain, and even the formation of a fistula between the oral cavity and the sinus.

In your case, it appears that the perforation has not healed for two years, and you are experiencing ongoing headaches, which may be related to the sinus issue. The presence of a dental crown or prosthesis covering the perforation complicates the situation. Typically, for successful surgical repair of a sinus perforation, the area must be adequately accessed, which often means that any covering prosthesis must be removed. This is crucial because the surgeon needs to visualize the perforation site to properly repair it and ensure that the sinus is free of infection or debris.

Here are some surgical options that may be considered for repairing a sinus perforation:
1. Direct Closure: If the perforation is small, the surgeon may be able to close it directly using sutures. This is often done under local anesthesia, and the recovery time can be relatively short.

2. Buccal Flap Technique: For larger perforations, a buccal flap (a flap of tissue from the cheek) may be used to cover the defect. This technique involves mobilizing tissue to provide a robust closure over the perforation.

3. Bone Grafting: In some cases, if there is significant bone loss or if the perforation is large, a bone graft may be necessary to provide support and facilitate healing.

4. Sinus Lift Procedure: If the perforation has led to significant sinus issues, a sinus lift procedure may be performed to elevate the sinus membrane and allow for bone grafting.

Regarding your concern about removing the dental crown, it is understandable to worry about the cost and potential complications of replacing it. However, it is essential to prioritize your health and the successful repair of the sinus perforation. If the crown is obstructing access to the perforation, it will likely need to be removed for the surgeon to perform the repair effectively. After the repair, your dentist can discuss options for replacing the crown, which may include making a new one or adjusting the existing prosthesis if possible.

It is also worth noting that if the perforation is left untreated, it can lead to chronic issues, including recurrent sinus infections, which may ultimately be more costly and complicated to manage than addressing the problem now.

In conclusion, while the removal of the dental crown may seem daunting, it is often a necessary step in the surgical repair of a sinus perforation. I recommend discussing your concerns with both your oral surgeon and your dentist to develop a comprehensive treatment plan that addresses both the perforation and the restoration of your dental function. Your health should always come first, and addressing the sinus perforation can lead to significant improvements in your quality of life.

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