Hi Kathy,
Sorry to hear about your problem.
The roots of the upper molar, bicuspid and, rarely, the canine teeth can border the maxillary sinus.
While the roots are usually separated from the sinuses by bone, sometimes the bone is as thin as tissue paper and on occasion, all that separates the two is the sinus membrane the Schneiderian Membrane. It a whitish, glistening membrane that is normally found surrounding the sinuses.
In infected teeth, the infection may have penetrated this membrane and nothing is between the tooth and the sinus. A difficult exraction may result in a perforation and, on occasion, broken root tips can be forced into the sinus cavity.
An extraction of such a tooth can lead to the perforation of the affected sinus. From the size of the hole that you discribed, my guess is that the infection had already penetrated. If the tooth was intact following the extraction, then you shouldn't have to worry about broken root tips.
A good post operative test is for the DENTIST to pinch the nose and have the patient breath out of the nose. If air or bubbles are noted in the extraction site, then there is a perforation.
If the patient notices a change in the sound of their voice, air escaping while talking, liquids draining out of their nose while drinking, they they have developed an Oral-Antral Fistula (Oro-Antral Fistula). The perforation and the fistula are actually different...the perforation may exist but the socket heals and seals the site. Only when the site communicates into the mouth is it a fistula.
Post operative instructions usually consist of warnings about blowing one's nose hard, blowing the nose with both nostrils open, opening the mouth during a sneeze. In addition, in the event, as yours, of a perforation, it is wise to go onto an antibiotic and a decongestant.
Should a fistula develope, the site must be closed by swinging a flap of skin from the surrounding area and covering the opening.
Most small perforations occurring during surgery will close spontaneously if you are careful. A large one like yours can be packed with Gelfoam or a Collaplug, sutured and actually has a good chance of closing.
If an actual fistula forms, this is more difficult to close and I would recommend an oral surgeon. Getting a fistula to close secondary to surgery can be more difficult. Follow all post operative instructions carefully.
As far as diving, I think DocVikingo is right. You may have to wait. First, the fistula must be closed and second, soft tissue and/or bone must start to fill the site.
I would certainly expect an minimum of 6 weeks for a successful closure before starting to dive again. You don't want to be forcing air into the sinus during a dive and risk blowing out the sinus. You also don't want to reintroduce oral contents into the sinus.
If you had a successful post-extraction closure, then you will be very close on this one. I cannot recommend that you dive. Your doctor should evaluate the site and repeat the x-ray before clearing you for your dive trip. Your sinuses should also be symptom free as well.
Good luck. Feel free to ask more questions.
Laurence Stein, DDS
:doctor:
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(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)
