When speaking about sinuses, we often refer to the sinus in the uper jaw, the so called maxillary sinus. Due to its close attachment to the roots of the upper lateral teeth, maxillary sinus is extremely important in stomatology.
What does the opening of the sinus occur?
Most commonly (more than 50%), the opening from the mouth cavity into the maxillary sinus occurs due to the laceration of the mucous membrane of the maxillary sinus.
It also occurs following the extraction of the upper lateral teeth, most frequently after the extraction of the first molar. This causes a pathological communication between the oral cavity and maxillar sinus to develop, the so called oro-antral communication.
The causes for the opening of the sinus can be:
- Anatomic –in rare cases when due to the lowered sinus, roots of teeth get in contact with its mucuous membrane.
- Inflamatory processes on the apex of the tooth root, leading to the bone mass destruction between the rooth and mucuous membrane of the sinus. Very often an opening from the mouth cavity to maxillary sinus is created during the extraction of the teeth (most common cause).
- Iatrogenic – the stomatologist’s mistake causes the opening from the mouth cavity into the maxillary sinus.
It should be emphasized that in many cases the occurence of an opening from the mouth cavity into the maxillary sinus during the tooth extraction passes unnoticed due to the development of the blood cloth and the small size of the pathological communication opening. The oro-antral communication is relatively common in stomatology and patients shouldn’t be worried since in majority of cases it is easily resolved. This is due to the fact that, after each tooth extraction in the uper jaw, the stomatologist applies a series of diagnostic procedures in order to find out whether the opening has occured and oro-antral communication has developed. The stomatologist would request „a nose blowing“ and „a puffed cheek“ test. If the patient cannot puff his/her cheeks, or the air comes out of the wound during the nose blowing test, both tests are positive and it is a clear sign that the opening between the mouth cavity and into the maxillary sinus was created. Other symptoms which can indicate an opened sinus are: inability to inhale a cigarette smoke, nasal speech, leakage of fluid through the nostril while rinsing it with water, unilateral nose bleed.
In such cases, it’s best the sinus is surgically closed, with a procedure also called „sinuplasty“. Being a simple surgery, it’s performed using the local anaesthetic and on-spot. If the intervention is not performed immediatelly, there’s an increased risk that the bacteries which normaly colonize the mouth cavity would move to the sinus and cause an infection.
It is very important for the patients to remember not to perform these tests on their own, because they can cause a perforation on the floor of the sinus, if done improperly. In that case, the problem wouldn’t be the result of the tooth extraction, but would instead be caused by the patient himself.