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Medical Edge Newspaper Column from Mayo Clinic
HOW A TOOTH EXTRACTION CAN LEAD TO SINUS TROUBLE
DEAR MAYO CLINIC: I have had a mouth problem for six years. It
all started after the extraction of a top tooth. The extraction released
lots of sinus stuff. Then I started to get sinus problems. I had sinus
surgery, and my head was better. But where the tooth was pulled I get
lots of sticky stuff out. No hole, but it’s getting worse. It’s salty
and pasty and grainy. The sinus doctor says it’s a tooth issue; the dentist
says it’s sinus-related. Please help me figure this out. — Minneapolis
ANSWER: Your history and symptoms suggest a problem that started
when you had your upper tooth removed six years ago. While your dentist
blames your sinus, and your physician blames your teeth, the problem most
likely relates to both.
The maxillary (upper jaw) teeth are very close to the maxillary sinus.
This relationship places the sinus at risk of injury during extraction
of upper back teeth.
The most likely explanation of your symptoms is an oral-antral fistula.
A fistula is an abnormal passageway between two parts of the body. When
your upper back tooth was removed, a passage was created between the extraction
site and your upper jaw sinus, or antrum (thus the name “oral-antral fistula”).
This complication is relatively common. In most instances, these passages
are very small and go unnoticed by the patient and the surgeon. Occasionally,
however, there are more extensive problems.
When a fistula doesn’t heal quickly, saliva from your mouth can enter
the sinus. Because saliva contains bacteria, patients can develop chronic
sinus infections, which often discharge material into the mouth. Sometimes,
this process goes on for years without treatment, and patients believe
this is normal. It is not. It can and should be treated.
Your surgeon will diagnose this problem by carefully examining your mouth
and nose. Sometimes, a small endoscope is used to look into the nose and
sinus. The procedure is painless. Imaging techniques, such as a CT scan,
can help pinpoint the problem and help your doctor determine proper treatment.
Treatment involves medications and minor surgery to close the fistula.
Antibiotics are often used to get rid of the sinus infection. Decongestants
help drain the sinus and alleviate pressure. Surgery — usually outpatient
— is then done to close the fistula. The surgery involves moving some
tissue near the fistula over the spot where saliva enters the sinus. Done
under general anesthesia, the surgery takes about 20 minutes, and recovery
takes about seven to 10 days.
Christopher Viozzi, D.D.S., M.D., Oral and Maxillofacial Surgery, Mayo
Clinic, Rochester, Minn.
Additional Resources:
Treatment of Oral-Antral
Fistula
Appointment
Information
READERS: Heart attacks and strokes occur most frequently in the
early morning hours. While researchers have known this for some time,
the reasons for it have not been clear. A new investigation helps explain
it, and may one day lead to new strategies for preventing heart attack
and stroke.
Here’s what researchers found: A layer of cells that lines the blood vessels
and helps regulate blood flow, called the endothelium, has natural periods
of reduced performance early in the morning. When this functioning is
reduced, blood vessels become inflexible. Inflexibility results in less
blood flow. Researchers suspect it may be among the triggers that lead
to a cardiovascular event such as heart attack, sudden death or stroke.
When researchers investigated the endothelium’s performance between 6
a.m. and 11 a.m., they discovered that the early-morning functioning of
endothelium naturally was reduced by more than 40 percent — and returned
to normal by 11 a.m. Even in healthy young test subjects, the early-morning
functioning of blood vessels approached the levels seen in smokers and
people with diabetes.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace
regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
- - -
Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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