Quote:
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)
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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?
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