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Sacamuelas
04-27-2004, 19:14
Originally posted by Kyobanim
While you're on the dental track . . .

You do an upper tooth extraction on a 40 year old female. When you get the tooth out you discover that the sinus was punctured while pulling the tooth.

How do you treat this in the field? (I have no idea but I thought I'd ask)

That can be confirmed by a nose-blow test... pinch nose closed and have patient GENTLY attempt to blow air out of it. IF it bubbles air through the extraction socket... you've got an exposure.

One thing to note, if you think it "might" be exposed, but you have no other indications that it is a large exposure( no large bony defect/no large piece of sinus floor attached to the the end of the root) then you may want to avoid this test and just treat as if it might. The reason is, sometimes the bony floor of the sinus can be breached but the membrane lining the sinus will still be intact. IF you perform a nose-blow test, it can rupture the membrane and cause an true opening. Just something to consider....

Back to your question:
In the field, you would pack extraction socket with surgicel, gel foam, or nothing(if you don't have either available). Then you would place a figure eight suture over the extraction socket to help hold in clot/packing or clot by itself.

Give the standard post-extraction instructions with the addition of following post-op care....

No forceful blowing of the nose
No use of straws
NO spitting
No smoking
Keeping mouth open when sneezing
Soft diet, no picking at ext socket
Antibiotics (PCN, Amoxicillin, or Clindamycin)
give Nasal decongestants x10-14 days: Systemic: Sudafed or similar med


HOpe that helps...did that cover what you wanted?

Kyobanim
04-27-2004, 20:15
Actually, the "bubbles through the extraction socket" was a little too much info for me but, yes, that answered the question.

Is this situation a common occurance? And what type of complications, if any, are common?

Just curious.

Sacamuelas
04-27-2004, 20:29
NO, not common, especially on a canine. Usually maxillary (upper) premolars and molars- if it is going to happen at all.

Other complications:


post-op bleeding
post op pain
post-op infection
ecchymosis (bruised appearance) of the cheeks/lips
are the more common things...


retained fragments of the root
fractured buccal (outside) alveolar bone when extracting
large sinus exposure
root or fragment of tooth actually pushed up into maxillary sinus
"slipped instrument" injury to surrounding tissue
much less common and most are preventable with good technique and precautions.


Let me guess.. to much info again. LOL

Well, you are on a professional website asking professional questions! haha:lifter

Bill Harsey
04-27-2004, 20:46
My Oregon Logger First Aid manual states that sinus is not punctured until daylight is showing. Now guess why I have this job instead of the refined trappings of a highly skilled Tactical Tooth Doc.

Sacamuelas
04-27-2004, 20:58
Originally posted by Bill Harsey
My Oregon Logger First Aid manual states that sinus is not punctured until daylight is showing. Now guess why I have this job instead of the refined trappings of a highly skilled Tactical Tooth Doc.

Not to hijack Kyo's thread... but I imagine a "sinus exposure" when using a chainsaw would most definitely be able to be diagnosed by seeing some daylight in the wound. Wait, you were referring to a logging term weren't ya'? hahaha

You're right though, LOL.. I'll deal with the mouth and sinuses, you keep making those beautiful/skilled knives, Sir. Now get back to that shop!!! I hear the wife coming around the corner....:eek:

back to thread....

DoctorDoom
04-27-2004, 23:56
x

Kyobanim
04-28-2004, 07:33
I can handle the info now.:D

Now I need to find a dictionary to look up those 'doctor words' you keep using.

Sinus exposure with a chain saw. I saw that in a movie once.

Bill Harsey
04-28-2004, 08:38
Sorry to get this thread skidding sideways, I've seen and assisted with the aftermath of some bad saw injuries. Won't describe here. back to serious business.

Sacamuelas
04-28-2004, 08:55
Originally posted by DoctorDoom
With a sinus exposure post-extraction can you continue tooth-brushing?

Yes... no contraindication for brushing. I would, however, advise that the patient not swish/gargle/rinse the socket for at least 48 hours. After 48 hrs post-op, gentle rinsing after meals can be performed.... key word to stress is gentle.

All precautions are aimed at keeping the clot in the socket.