Managing Sinusitis Symptoms After Oral-Nasal Fistula Surgery

Q: Managing Sinusitis Symptoms After Oral-Nasal Fistula Surgery

Hello： It is difficult to provide you with specific advice without seeing your condition in person at the clinic. <br>I hope you can visit the oral surgery department for a re-evaluation and treatment.

Symptoms of sinusitis after nasal and oral fistula surgery?

Dear Doctor,
Recently, I had a tooth extraction that resulted in an oroantral fistula.
I underwent a first repair surgery where collagen was used to close the wound.
However, a few days before the stitches were to be removed, I returned for a follow-up and found that the wound had opened again.
Consequently, I had to undergo a revision surgery.
After the stitches were removed about two weeks later, I noticed that the wound had opened slightly again.
I then sought treatment at a different clinic, where I underwent another revision surgery.

However, about four days post-surgery, I began to experience sharp pain at the wound site, as well as pain in my nasal bridge and face.
I visited a nearby ENT specialist twice and took medication for four days, but it was ineffective.
I then went to a large hospital's ENT department, where they informed me that I would need endoscopic sinus surgery to drain the pus and that I should also see an oral surgeon, as the wound might require further intervention.

I would like to ask the doctor: Is it not possible to create a drainage opening directly from the fistula site? Is endoscopic surgery absolutely necessary? Additionally, the doctor prescribed antibiotics and antihistamines and advised me to return for a follow-up in a week.
However, I am experiencing severe pain in my mouth, nasal bridge, and cheek at specific times each day.
What should I do? Should I wait for another week?

ben, 20~29 year old female. Ask Date: 2010/05/10

Dr. Zhuang Suhui reply Dentistry

Hello: It is difficult to provide you with specific advice without seeing your condition in person at the clinic.
I hope you can visit the oral surgery department for a re-evaluation and treatment.

Reply Date: 2010/05/10

More Info

Managing sinusitis symptoms after oral-nasal fistula surgery can be quite challenging, especially considering the complications you've experienced. It sounds like you've gone through multiple surgeries to address the fistula, and now you're dealing with pain and potential sinus issues. Let's break down your situation and explore the best course of action.

First, it's important to understand that after any surgical procedure, especially one involving the oral and nasal cavities, there can be significant swelling and inflammation. This can lead to symptoms similar to sinusitis, such as facial pain, nasal congestion, and pressure. The fact that you've had multiple surgeries may contribute to ongoing inflammation and discomfort, as the tissues in the area can be quite sensitive and take time to heal.

Regarding your specific questions:
1. Can the drainage be done directly from the fistula site?
In some cases, it may be possible to create an opening for drainage directly from the fistula site. However, this depends on the specific anatomy of your situation and the extent of the sinus involvement. An endoscopic sinus surgery (ESS) is often preferred because it allows for a more thorough examination and cleaning of the sinus cavities. This can help ensure that any infected or obstructed areas are properly addressed, which may not be achievable through a simple drainage procedure.

2. Is endoscopic surgery necessary?
If your ENT specialist has recommended endoscopic surgery, it is likely because they believe that this approach will provide the best chance for resolving your symptoms and preventing further complications. Endoscopic surgery allows for direct visualization of the sinus cavities, enabling the surgeon to remove any obstructive tissue, polyps, or pus that may be causing your symptoms. This can be particularly important if you are experiencing significant pain and pressure, as it may indicate that there is an ongoing infection or blockage.

3. What should you do about the pain?
Since you are experiencing significant pain, especially around the mouth and nasal bridge, it is crucial to communicate this to your healthcare provider. If the pain is severe and not responding to the medications prescribed, you may need to follow up sooner than the scheduled appointment. Pain management is an essential part of recovery, and your doctor may need to adjust your medications or explore other options to help alleviate your discomfort.

4. Waiting for a week:
While it is often advisable to give medications time to work, if your pain is worsening or if you develop new symptoms (such as fever, increased swelling, or drainage), you should seek medical attention sooner. Your health and comfort are paramount, and it’s better to err on the side of caution.

In summary, managing sinusitis symptoms after oral-nasal fistula surgery requires careful monitoring and communication with your healthcare providers. If your symptoms persist or worsen, do not hesitate to seek further evaluation. It's essential to ensure that any underlying issues are addressed promptly to facilitate healing and improve your quality of life. Remember, recovery can take time, and it's important to be patient with your body as it heals.

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