Immediate Treatment

Immediate Treatment

The best treatment of a potential sinus exposure is avoiding the problem through careful observation and treatment planning. Evaluation of high-quality radiographs before surgery begins usually reveals “the presence .or , absence of an excessively pneumatized sinus or widely . divergent or dilacerated roots, which have the potential of having a communication with the sinus or causing fractures in the bony floor of the antrum during removal (see Fig. 1~-7). If this observation is made, surgery may be altered to section the tooth, and remove it one root at a time (see Chapter 8). ‘ When exposure and perforation of the antrum result,the least invasive therapy is indicated initially. If -the opening to the sinus is small and the sinus is disease free, efforts should be made to establish a blood.clot in the extraction ‘site and preserve it in place. Additional soft tissue= elevation is not required. Sutures are placed to reposition the soft tissues, and a gauze pack is,placed over the surgical site for to 2 hours. The patient is instructed to use nasal precautions for 10 to 14 days. These include opening the mouth while sneezing, not sucking on a straw or cigarettes; and avoiding nose blowing and any other situation that may produce pressure changes between the nasal passages and oral cavity. The patient is placed on an antibiotic, usually penicillin; an antihistamine; and a systemic decongestant for 7 to 10 days to” prevent infection, to shrink mucous membranes, and to lessen nasal and sinus secretions. The patient is seen postoperatively at 48- to 72-hour intervals and is instructed to return if an oroantral communication becomes evident by leakage of air into the mouth or fluid into the nose ‘or if symptoms. of maxillary sinusitis appear, The majority of patients treated in this manner heal uneventfully if there was no evidence of preexisting sinus , disease. If larger perforations occur, the patient should be referred to an oral and maxillofacial surgeon for immediate treatment.

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