Sinus squeeze after wisdom tooth extraction

[Chris Ross]

Hi all, question regarding my daughter, she had her wisdom teeth surgically removed and I think the operation didn't go so well, took a long while to heal properly and after it had when diving she experiences sinus squeeze, when it was all fine and normal beforehand. We believe they nicked one of her sinuses in the operation. She had all four teeth out under a general. Two years on we dived today and she experienced pain when surfacing and bubbling/clicking in the ear. Her jaw muscles also seem a little weak and she has had trouble holding the reg in at times, though much better with a moldable mouthpiece for the reg.

The Question is if it possible to do anything about this to enable diving again? Not expecting a diagnosis more which particular specialist would deal with this sort of problem and if anything can be done to improve the situation? I find it's better to go to your doctor armed with some ideas rather than hope for the best. I could probably go through DAN to get a recommendation for an appropriate specialist to ask for a referral to.

 

[Duke Dive Medicine]

Hi all, question regarding my daughter, she had her wisdom teeth surgically removed and I think the operation didn't go so well, took a long while to heal properly and after it had when diving she experiences sinus squeeze, when it was all fine and normal beforehand. We believe they nicked one of her sinuses in the operation. She had all four teeth out under a general. Two years on we dived today and she experienced pain when surfacing and bubbling/clicking in the ear. Her jaw muscles also seem a little weak and she has had trouble holding the reg in at times, though much better with a moldable mouthpiece for the reg.

The Question is if it possible to do anything about this to enable diving again? Not expecting a diagnosis more which particular specialist would deal with this sort of problem and if anything can be done to improve the situation? I find it's better to go to your doctor armed with some ideas rather than hope for the best. I could probably go through DAN to get a recommendation for an appropriate specialist to ask for a referral to.

Hi @Chris Ross ,

Interesting that there are two ENT-related threads from eastern Australia going on at the same time. From your post in the other thread, it looks like you already know of an ENT with some experience with divers (the one in Miranda who saw you for the barotrauma last March). You might check with him to see if he's willing to see her. You might also consider contacting Dr. Mike Bennett in Sydney. His contact info is in the other thread but I'll link it again below for continuity.. He's a very well-known and highly respected diving physician.

Assoc Prof Mike | SPUMS

Best regards,
DDM

 

[Chris Ross]

Hi @Chris Ross ,

Interesting that there are two ENT-related threads from eastern Australia going on at the same time. From your post in the other thread, it looks like you already know of an ENT with some experience with divers (the one in Miranda who saw you for the barotrauma last March). You might check with him to see if he's willing to see her. You might also consider contacting Dr. Mike Bennett in Sydney. His contact info is in the other thread but I'll link it again below for continuity.. He's a very well-known and highly respected diving physician.

Assoc Prof Mike | SPUMS

Best regards,
DDM

Thanks for the information - I'll look into that. I was also hoping for some indication about potential for treatment and I'm assuming for the moment an ENT specialist is the specialty to diagnose and fix such a problem - more so than the oral surgeon which caused the problem.

 

[Duke Dive Medicine]

Thanks for the information - I'll look into that. I was also hoping for some indication about potential for treatment and I'm assuming for the moment an ENT specialist is the specialty to diagnose and fix such a problem - more so than the oral surgeon which caused the problem.

Hi Chris, without imaging and examination of the area it would be pretty hard to tell what's going on. With the caveat that this isn't my specialty, the roots of the upper molars do come pretty close to one of the sinuses, but there's a lot of anatomic variation. A more common sinus complication after dental extraction would be an open fistula between the sinus and the mouth, and your daughter would probably know it if she had that. I wouldn't want to speculate on other complications, though nicking the sinus as you suggested sounds like it would be pretty difficult unless the oral surgeon had to do something really aggressive to get one of the molars. You mentioned that your daughter heard bubbling and clicking in her ear, which suggests middle ear barotrauma, not sinus barotrauma. Weak facial muscles could indicate facial baroparesis - the facial nerve runs right by the middle ear space and if there is excess pressure in that space, it can result in temporary muscle weakness or paralysis on the affected side.

Put all this together, and it's pretty complex, thus the recommendation to see an ENT for evaluation.

Best regards,
DDM