Oral and Maxillofacial Surgery Expert Forum
oroantral fistula/communication nightmare: what should I do?
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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oroantral fistula/communication nightmare: what should I do?

I am a healthy male in my late twenties. I had wisdom teeth extraction surgery 4 weeks ago. The doctor said nothing about a complication after the surgery, but I realized quickly that I have a hole at the location of my upper left wisdom tooth extraction site to my sinus. I am truly having a miserable time since then.
I had a mild nose bleed the day after the surgery from both sides. For the first 10 days or so the hole was big enough that mucous from the sinus would leak heavily down to my mouth almost all day long, and liquids would go up from my mouth into my sinus and out of my nose without applying any pressure.
I saw the doctor 2 weeks after the surgery (he was out of town!), and by that time the hole was much smaller, but I was sure it was not closed yet. He assured me it was practically closed and doing a flap surgery could hurt more than help. I will see him again in couple of days, but my main problem is that I do not trust a word of what he says.
I was on amoxicillin for the first 10 days, and after seeing him he renewed amoxicillin for another 10 days.
Now 4 weeks after the surgery it is better, but I still notice the taste is mucous leaking from that side occasionally. I can drink liquids and with very little going into my sinus. I feel sick with a mild fever for half a day or so every few days. The location of the extraction is still sore and tender, and I still have bad headaches on my left side of the face, and strong sinus pressure even though I can breathe freely most of the time.
Is it possible for such an established oroantral communication to heal on its own, and how long should I wait? And most importantly is it possible to have the illusion of fistula being closed but never healing 100% and thus giving me bad chronic sinus infections like some of the scary cases I read on the internet? Is waiting worth the risk of the bad infections and headaches that I am having?
And should I see an ear, nose, and throat doctor to manage my sinus problems?
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Sinus communiation is a well known and unfortunate complication of wisdom tooth removal.  It can also occur when doing other procedures in the back of the upper jaw.

If the communication is small, it can heal spontaneous within a couple weeks.  Being the time lapse since your surgery and your current sign and symptoms,it sounds that the communication is still open and needs to be promptly addressed.

Surgical closure is a common procedure and quite sucessfully in the majority of cases.  Sinus infections and inflammation is a sign of an oral sinus communication and usually resolves once the communication is repaired.

I recommend that you speak to the surgeon directly who performed the extraction about your "trust" issues.  If you are not comfortable after speaking with them then I suggest you find a Board Certified Oral and Maxillofacial Surgeon and promptly make an appointment to be seen.

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
Thank you very much for your comments. I live in Ontario, Canada. I already tried to see another oral surgeon when I realized that mine was out of town, but when I called another surgeon's office, they told me the doctor will not see your case without a referral from your original doctor (for legal reasons etc..etc..). I called my surgeon's office and requested to be referred to another surgeon and they said they cannot do that, you will have to see the same doctor. I had to go to another city to see him because I was seriously concerned (2 weeks after the surgery) and that's when he assured me that it seems to be closed. I will see him again in two days, and do not know my rights or the proper procedure to get him to refer me to someone else? how do I do that without making a fuss, I simply want a second opinion?
Thanks again,
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