Closure Of Sinus Communication

Sinus problems after tooth extraction

What is an Oro-Antral Communication (OAC)?
OAC is a small opening between your mouth and your sinus (an air space near your nose and upper back teeth).
This opening can happen when a back tooth (molar or premolar) in your top jaw is taken out, especially if the roots are very close to or inside the sinus.

It can also happen if a piece of a tooth root breaks during removal and enters the sinus.

This may allow drinks or other fluids to pass from your mouth into your nose.

You might also find it hard to smoke, drink through a straw, or play wind instruments.

If not treated, the OAC may turn into a more serious problem called an oro-antral fistula (OAF)—a tunnel that can cause ongoing sinus infections.

Signs you may have an OAC

• The tooth socket doesn’t heal
• You feel food or liquid going into your nose when eating or drinking
• You feel air move through the area when breathing
• You keep getting sinus infections
• One side of your nose feels blocked or has discharge
• Pain or pressure in your cheek or under your eye
• Ongoing dull pain or pressure on one side of your face

Does it need to be repaired?
Sometimes, small openings heal by themselves.
But if the opening is large, or if healing is delayed (especially in people who smoke), surgery may be needed to close it. This can take place either immediately after a tooth is removed or several days-weeks after.

How is an OAC repaired?
The most common repair method involves:

• Lifting the gum and tissue near the area
• Stretching this tissue over the hole and stitching it in place using dissolvable stitches

This is usually done with local anaesthetic (you stay awake), and works in over 95% of cases. If it doesn’t work, or if the hole is large, another surgery may be needed.

If a root piece is stuck in the sinus, we may:

• Wash out the sinus
• Use tissue from your cheek to close the hole
• Stitch the area with dissolvable stitches, which go away in 2 to 3 weeks

What are the risks of this surgery?

• Some blood in your spit for the first 24 hours
• Pain or discomfort (you can use regular painkillers and may be given antibiotics)
• Stitches can trap food and bacteria if the area isn’t kept clean
• Feeling blocked or stuffy—nasal sprays or steam inhalation may help
• Some swelling or bruising which can form under the eye and on the cheek (usually worst on day 5, then it gets better)

Things to avoid
To help the area heal and prevent problems:

• Don’t blow your nose or pinch your nose when sneezing
• Don’t use a straw
• Don’t blow up balloons, play wind or brass instruments, go scuba diving, or fly—for at least 6 weeks
• Don’t eat hard or chewy foods like steak, crisps, or crusty bread
• Avoid heavy lifting or strenuous exercise
• Smoking should be avoided because:
  • It increases pressure in the sinuses, which may stop healing
  • It raises the risk of infection